Abstract

Advances in antiretroviral therapy transformed HIV infection into a chronic condition, resulting in a rapidly 
growing population of older adults living with HIV who experience a disproportionate burden of metabolic and 
cardiovascular comorbidities. This review examined the biological mechanisms, clinical manifestations, and 
therapeutic implications of metabolic dysfunction and cardiovascular risk among aging populations with chronic 
HIV infection. A narrative and critical review of peer-reviewed literature was conducted, synthesizing 
epidemiological, clinical, and mechanistic studies relevant to HIV-associated metabolic and cardiovascular disease. 
Persistent immune activation, chronic inflammation, antiretroviral therapy–related metabolic effects, and age
related physiological changes synergistically contributed to insulin resistance, dyslipidemia, visceral adiposity, and 
accelerated atherosclerosis in older adults with HIV. These abnormalities significantly elevate cardiovascular risk, 
often exceeding that observed in HIV-negative populations of similar age. Conventional cardiovascular risk 
prediction tools frequently underestimate risk in this population, complicating clinical management. Metabolic 
dysfunction and cardiovascular disease represented major determinants of morbidity and mortality in aging 
individuals with chronic HIV infection, necessitating integrated, mechanism-informed prevention and management 
strategies tailored to this population.