Background
Advances in antiretroviral therapy have improved survival, leading to a growing population of older adults living with HIV. Population level data on aging related outcomes and health care utilization in this group are limited.
Methods
We conducted a population based matched cohort study in Ontario, Canada. The study cohort included 2,826 individuals diagnosed with HIV between April 1, 2005 and March 31, 2020 who were aged 50 years and older. Matched controls were Ontario residents without HIV, matched on age, sex, and rurality. Outcomes included mortality, hospitalization, emergency department visits, hospital length of stay, frailty, neighbourhood income quintile, and prior health care use measured using Resource Utilization Bands (RUB) in the 2 years before baseline.
Results
Within 1 year of diagnosis, mortality was higher among older adults living with HIV (264 deaths, 9.3%) than controls (34 deaths,1.2%;SD 0.37; p< .0001). Mortality rates remained higher at 3 years (55.2vs12.1 deaths/1,000 py) and 5 years (44.7 vs 13.3 deaths/1,000 py) (all p< .0001). Hospitalization>1 year occurred in 34.3% of older adults living with HIV versus 5.9% of controls (SD 0.757;p<.0001). Emergency department visit rates at 1 year were 1,112.4 versus 382.9/ 1,000 py (p<.0001), with persistently higher rates at 3 and 5 years. Hospital length of stay was higher among older adults living with HIV at all follow up periods (all p< .0001). Frailty in the 2 years prior to baseline was more common among older adults living with HIV (12.1%vs3.2%;SD 0.339;p<.0001). Prior health care utilization differed, with fewer low users (RUB0–2: 27.6% vs 19.1%), more moderate users (RUB3:48.7%vs31.1%), and more high users (RUB4–5:23.8%vs49.8%) (p< .0001).
Interpretation
Older adults living with HIV experience higher frailty, mortality, and sustained excess health care utilization, supporting the need for aging focused models of care and targeted research.

People living with HIV (PLWH) exhibit persistent immune activation and chronic inflammation despite successful antiretroviral therapy, contributing to chronic comorbidities. Additionally, HIV is associated with increased risk of geriatric syndromes, such as frailty. However, the underlying mechanisms leading to frailty, particularly among older PLWH, remain unknown. We aimed to identify serum proteomic signatures associated with frailty in this population. PLWH were selected from the Correlates of Healthy Aging in Geriatric HIV study, including frail (n = 44), pre-frail (n = 70), and non-frail (n = 18) individuals, as assessed using Fried’s criteria. HIV-negative individuals (n = 40) served as controls. Serum proteomic levels were measured using the Olink Reveal assay, based on the principles of the Proximity Extension Assay. Unsupervised clustering was initially performed using principal component analysis and heatmap visualization. Protein expression differences between groups were calculated as log₂ fold-changes and corrected using the Benjamini-Hochberg method. Gene Ontology enrichment analysis was conducted using Enrichr, and protein-protein interaction networks were explored via STRING. A total of 62 out of 1,034 proteins were differentially expressed; 51 were upregulated and 5 were downregulated in frail PLWH compared to controls. The top five upregulated proteins were LY9, PRELP, LIFR, VEGFB, and GCNT1, while the top five downregulated proteins were CLEC4A, CTSV, NAGA, TMEM106, and MUC20. Most of these proteins are involved in inflammatory and senescence-related processes. Multinomial logistic regression highlighted 52 proteins that significantly altered the odds of a frail classification whilst adjusting for sex, age, body mass index (BMI), chronic obstructive lung disease and asthma. Validating these biomarkers could enable their translation into predictive tools for early triage and clinical decision-making, with the potential to transform frailty care through timely prevention and targeted monitoring.

Background: Recent studies show higher mortality in women vs. men living with HIV in British Columbia (BC), although drivers of the mortality gap, whether socio-structural, biological, or HIV-related, are not fully elucidated. PhenoAge is a biological age estimator that reflects health status and mortality risk better than chronological age. We evaluated PhenoAge, stratified by HIV status and by lifetime experience of homelessness, both reported predictors of adverse health outcomes.
Methods: BCC3 is a cohort enrolling socio-demographically similar women aged ≥16y, living with and without HIV in BC. PhenoAge(y), based on 9 blood measures (cell counts, metabolism, C-reactive protein), was calculated using survey data and clinical laboratory results. Lifetime history of homelessness was self-reported. Descriptive statistical analyses employed Spearman’s correlation, Mann-Whitney, and Wilcoxon tests.
Results: This analysis included 493 women recruited between Dec 2020-July 2024 (40% living with HIV; median [IQR] age 48[37-57]y). PhenoAge was strongly correlated with chronological age (rho=0.88, p<0.0001). Women living with HIV (WLWH) (n=196, 87% HIV undetectable) were older than controls (n=297); 49[41-58] vs 46[33-57]y, p=0.005. Median PhenoAge and chronological age were similar in WLWH (50[40-60] vs 49[41-58]y, p=0.92), but differed slightly in controls (45[31-58] vs 46[33-57]y, p=0.001). Women who experienced homelessness ever, representing 39% of the cohort (n=193; 87 WLWH and 106 controls), were older than those who did not (51[42-58] vs 47[32-57] y, p=0.001), and median PhenoAge was 2y higher than chronological age (53vs51, (p<0.0001). The opposite was true for women with no experience of homelessness, for whom PhenoAge was 3y lower than chronological age (44vs47, p<0.0001).
Conclusions: In this cohort of women with high rates of adverse life experiences, having a history of homelessness was associated with older PhenoAge, while living with HIV itself showed little difference. This reinforces the need to consider social context when investigating aging biomarkers, especially in more vulnerable populations.

Background: HIV care cascades demonstrate progress towards UNAIDS targets but may not fully capture dynamic and long-term outcomes. Using data from the Quebec HIV Cohort (QHC), we examined cascade and longitudinal patterns of care engagement, viral suppression (VS), and loss to follow-up (LTFU) over five years.
Methods: The QHC includes 12939 people receiving HIV care at six clinics across Quebec since early pandemic. We here included individuals with ≥1 HIV viral load (VL) reported in 2017-2023. Cascade variables were defined as: “engaged in care” (≥1VL measurement within a year), “on antiretroviral therapy (ART)” (prescribed ART before/during the year), “VS” (VL <200 copies/mL at last measurement of year). For longitudinal analyses, individuals were assigned mutually exclusive annual statuses: “New patient” (regardless of VL), “VL<200”, “No VL but stable” (no VL that year but VS documented before and after), “VL>200”, “Moved”, “Died”, and “LTFU” if none of previous applied.
Results: A total of 8882 people living with HIV were engaged in care at some point between 2018 and 2023. Among those engaged in care, ART coverage was 98% (95%CI:97-98) in 2018 and 98% (95%CI:98-98) in 2023. Of those on ART, VS was achieved by 97% (95%CI:96-97) in 2018 and 97% (95%CI:97-98) in 2023. Stratified cascade analyses for 2023 showed VS below 95% among individuals aged <30 years; of Indigenous ethnicity; with a lifetime history of injection drug use; and those with vertically acquired HIV. Annually, 242-427 new patients entered the cohort, 5-15% of people with VS in the previous year were LTFU, while 11-22% of those LTFU were re-engaged after a median of 2 years (range 1-5).
Conclusion: High ART coverage and VS were observed using cross sectional cascades, yet longitudinal analyses demonstrated frequent transitions into and out of care. Integrating longitudinal measures provide a more complete understanding of HIV care continuity.

Background: Healthcare providers (HCPs) are key to supporting older adults living with HIV as health needs become more complex with age. They often identify changing needs, initiate conversations about home care and continuing care, and help patients navigate referrals, eligibility, and privacy or safety concerns. We explored HCP perspectives on continuing care services for older adults living with HIV in Alberta.

Design: We used purposive sampling to recruit 14 HCPs with current or past experience caring for older people living with HIV through the Southern Alberta Clinic (SAC). Semi-structured interviews were analyzed thematically using a framework approach informed by the 2024 Alberta Quality Matrix for Health (accessibility, acceptability, appropriateness, effectiveness, safety, efficiency).

Setting: Southern Alberta Clinic (SAC), Calgary, Alberta, Canada.

Participants: Fourteen HCPs (physicians, nurses, social workers) and community-based organizing staff involved in care for PLWH aged ≥50 years.

Results: Across interviews, providers most often emphasized efficiency, safety, and effectiveness, using limited resources well, protecting confidentiality and privacy, and supporting strong outcomes. Appropriateness and acceptability were also prominent, with attention to respectful, relevant, evidence-informed care aligned with older patient needs. Familiarity with home care and continuing care pathways differed by role: physicians, social workers, and community workers described distinct responsibilities and levels of involvement in referral and navigation.

Discussion/Conclusions: HCPs described quality largely in clinical terms, using limited resources carefully, reducing risk, and delivering evidence-informed care to support optimal? outcomes. Accessibility was discussed less often, highlighting an opportunity to improve access considerations in routine care planning. Attending to these perspectives alongside patient priorities can guide practical changes that improve access to home care and continuing care while prioritizing patient-centred clinical processes.