Aging-related comorbidities among people living with HIV in Sub-Saharan Africa: a scoping review

With improved antiretroviral therapy (ART), people living with HIV (PLHIV) live longer; however, the longer they live, the higher their risk of aging-related comorbidities. This scoping review aims to ascertain the burden of aging-related comorbidities among PLHIV in Sub-Saharan Africa. For this review, “older adults” refers to individuals aged 50 years and above, consistent with UNAIDS and global HIV-aging research conventions. Age groups used across the included studies defined younger adults as < 50 years, middle-aged as 40–49 years, and older adults as ≥ 50 or ≥ 60 years depending on study aims. These definitions guided interpretation and comparison of comorbidity patterns across studies. This scoping review was conducted using literature obtained from PubMed, Embase, Scopus, Web of Science and CINAHL. Studies published from 2013 onwards were included, focusing on the burden of non-AIDS comorbidities in PLHIV. 12 studies were included in this study. Findings from this study demonstrated that PLHIV experience a higher prevalence and earlier onset of non-AIDS comorbidities (NACMs) compared to HIV-negative peers, with nearly half of older PLHIV having at least one condition. Reported prevalence was high, including diabetes (up to 18%), neurocognitive impairment (15–71%), malignancy (12%), hypertension (40–68%), and liver disease (up to 10-fold higher vs. controls). Comorbidity occurred earlier (by 5–12 years) and was approximately double in PLHIV, with older adults having almost five times greater odds of comorbidity than younger peers. Women also carried a significantly higher burden than men, particularly for psychiatric illness, anemia, and bone disease. Persistent inflammation despite ART was linked to cardiovascular disease, diabetes, renal failure, and cancer. These findings highlight a disproportionate, age- and sex-specific burden of comorbidity in PLHIV, underscoring the need for integrated comorbidity screening and management in HIV care. The review identified the burden of comorbidities among aging PLHIV and highlighted the need for integrated care models addressing both HIV and aging-related comorbidities. Strengthening healthcare systems to provide comprehensive care to PLHIV as they age is crucial. This scoping review underscored the significance of aging-related comorbidities among PLHIV in Sub-Saharan Africa, emphasizing the need for tailored screening and prevention strategies. Further research is necessary to understand the complex interplay between HIV, aging, and comorbidities in this region.