The life expectancy of HIV-infected patients treated with
highly active antiretroviral therapy (
HAART) has increased and now approaches that of the general population, while also the definition of
AIDS has lost most of its epidemiological and clinical significance, due to the immune recovery obtained by large-scale administration of potent antiretroviral combinations. The prolonged survival of subjects with
HIV infection, and the late recognition of patients with occult disease, will contribute to a progressive increase in disease incidence in patients aged 50-60 years or more in the near future. Unfortunately, the large majority of therapeutic trials addressed to assess and compare novel antiretroviral molecules and associations, as well as studies regarding antimicrobial
chemotherapy of prophylaxis of
AIDS-related opportunistic infections, have just advanced age and/or underlying chronic disorders (i.e. liver or
kidney failure) among main exclusion criteria, or do not allow the extrapolation of data regarding older subjects, compared with younger ones. The limited data available until now show that antiretroviral
therapy has a similar virological efficacy in the elderly compared with younger patients. However, immune reconstitution is often slower and blunted according to age progression, although some well-designed studies have shown that the thymic function (which controls most quantitative and functional immune recovery) can be preserved in adults and even in advanced age. When facing older subjects, the
Infectious Disease specialist has to pay careful attention to any chronic end-organ disorders, all possible pharmacological interactions, and overwhelming toxicity due to underlying
drug therapies: all these issues may significantly interfere with
HAART efficacy, patients' adherence to prescribed treatments, and frequency and severity of untoward events. Guidelines for antiretroviral
therapy and treatment and prophylaxis of
AIDS-associated illnesses should be appropriately updated, given the novel features due to the emerging increase in the mean age of the HIV-infected patient population.