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Care for Aging With HIV
Comprehensive Care for Aging Individuals With HIV: Innovative Lessons for Malawi and Across the Globe

Released: November 20, 2025

Violet Zulu
Violet Zulu
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Key Takeaways
  • It is critical to treat HIV and its related comorbidities together in aging people by addressing physical, mental, and social health as interconnected needs.
  • Simplified ART regimens are safe and effective for older adults and may help reduce pill burden, improve adherence, and minimize drug interactions.

As an HIV advocate working in Malawi, I have witnessed both the triumphs and the ongoing challenges faced by people living with HIV, particularly as they age. Many of the older adults I work with have lived with HIV for decades, embodying resilience while navigating new health challenges: hypertension, diabetes, frailty, depression, and social isolation. Their experiences have strengthened my belief that it is time for Malawi to embrace comprehensive, person-centered care that recognizes aging with HIV as a complex, lifelong journey.

What Is Effective Care for Older People Living With HIV?
Recent research paints a clear picture of what effective care can look like. The AGEhIV cohort study demonstrated that when comprehensive comorbidity management and consistent antiretroviral therapy (ART) are in place, aging individuals with HIV can enjoy a health-related quality of life comparable to those without HIV.

Similarly, the Mobile Outreach Retention and Engagement (MORE) program showed that mobile and community-based care significantly improve retention and viral suppression among those who struggle to stay engaged in traditional clinic systems. These lessons hold powerful relevance for Malawi, where distance, stigma, and resource limitations remain major barriers to consistent care.

A study assessing frailty in older people with HIV further deepened my understanding of aging with HIV. It showed that frailty and multimorbidity occur at younger ages among people living with HIV and that comprehensive geriatric assessments can help address vulnerabilities early. I have seen this reality in my advocacy work with older people living with HIV who face mobility challenges, chronic pain, or mental health issues but rarely receive integrated care. The study’s emphasis on the 5Ms of geriatrics—Mind, Mobility, Medications, Multicomplexity, and What Matters Most—offers a framework we can adapt in Malawi to make care more responsive and holistic.

At the same time, the association between frequent insurance changes and delayed administration of cabotegravir plus rilpivirine, reported at IDWeek, highlights how system-level issues can disrupt continuity of care, even in well-resourced settings. In Malawi, we face similar challenges, albeit not from insurance transitions, but from drug stockouts, staff shortages, and limited infrastructure. The study’s findings remind me that proactive systems implementing consistent follow-up, contingency plans, and dedicated coordination are essential to maintaining uninterrupted treatment and trust in care programs.

Adding to this growing body of evidence, the global REGAL study provides encouraging insights for aging individuals with HIV. Conducted across 7 countries, this real-world retrospective chart review found that  dolutegravir/lamivudine was as effective and well-tolerated as bictegravir/emtricitabine/tenofovir alafenamide among older adults with multiple comorbidities. More than 80% of participants had at least 1 chronic condition, yet sustained viral suppression was achieved with fewer drugs. This real-world evidence shows that simplified ART approaches can maintain viral control while reducing the number of active agents and potential drug interactions, an important consideration for aging populations managing multiple medications.

Key Priorities for Thriving With HIV
Together, these studies underscore a common message: older people living with HIV can thrive when care is integrated, adaptive, and person-centered. Drawing from both global evidence and local experience, I believe the current HIV response must now pivot toward 3 key priorities:

1. Holistic and Integrated Care: We must treat HIV and its related comorbidities together, by addressing physical, mental, and social health as interconnected needs.

2. Innovative and Flexible Service Delivery: As demonstrated in the MORE program, mobile outreach, community-based programs, and home-based follow-ups should be scaled up. Such models reduce treatment barriers for aging people who face mobility challenges, stigma, or financial hardship.

3. Simplified and Sustainable Treatment Options: The REGAL study demonstrates that simplified ART regimens are safe and effective for older adults. Adopting similar approaches in Malawi could reduce pill burden, improve adherence, and minimize drug interactions, which are all critical factors for aging individuals managing multiple conditions.

As someone who has worked closely with communities in Malawi, I know that aging with HIV is about more than surviving—it is about living fully, with dignity and support. The science has shown us the path forward; what remains is the collective will to act.

It is time for Malawi to integrate geriatric principles, strengthen health systems, and ensure every aging individual living with HIV receives comprehensive, compassionate care. By combining evidence with empathy, we can create a future where our elders living with HIV not only survive, but thrive.

Your Thoughts
What do you do in your practice to ensure that older people living with HIV continue to thrive? Leave a comment to join the discussion!

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