It is estimated that by 2015 more than half of all HIV-infected individuals in the United States will be 50 years of age or older. As this population ages, the frequency of non-
AIDS related comorbidities increases, which includes cardiovascular, metabolic, gastrointestinal, genitourinary and
psychiatric disorders. As a result, medical management of the aging HIV population can be complicated by
polypharmacy and higher pill burden, leading to poorer antiretroviral
therapy (ART) adherence. Adherence to ART is generally better in older populations when compared to younger populations; however,
cognitive impairment in elderly patients can impair adherence, leading to worse treatment outcomes. Practical monitoring tools can improve adherence and increase rates of viral load suppression. Several antiretroviral drugs exhibit inhibitory and/or inducing effects on
cytochrome P450 isoenzymes, which are responsible for the metabolism of many medications used for the treatment of comorbidities in the aging HIV population. The combination of ART with
polypharmacy significantly increases the chance of potentially serious
drug-drug interactions (DDIs), which can lead to
drug toxicity, poorer ART adherence, loss of efficacy of the coadministered medication, or virologic breakthrough. Increasing clinicians awareness of common DDIs and the use of DDI programs can prevent coadministration of potentially harmful combinations in elderly HIV-infected individuals. Well designed ART adherence interventions and DDI studies are needed in the elderly HIV population.