Comparison between the HIV population and the population attending the cardiogeriatrics clinic: analysis of clinical and geriatric characteristics

Background The widespread use of antiretroviral therapy has transformed HIV into a manageable chronic condition, resulting in an increasingly aging population of people living with the virus. These older adults often experience a premature-aging phenotype driven by persistent immune activation and chronic inflammation, which promotes the early development of cardiovascular and age-related comorbidities. Consequently, both older adults with HIV and patients in cardiogeriatric settings frequently present with high burdens of multimorbidity, polypharmacy, and frailty. Objective This study aims to compare the clinical manifestations, metabolic profiles, and cardiovascular characteristics of older people living with HIV with those of patients attending a cardiogeriatrics clinic. Specifically, it seeks to determine whether the clinical phenotypic overlaps between these populations necessitate a convergence of care models, and whether persistent chronic inflammation contributes to distinct cardiovascular and frailty trajectories. Materials and Methods A cross-sectional multicenter observational analysis was conducted on patients aged ≥65 years included in the GEPPO database, comparing subjects with and without HIV infection. The evaluation assessed cardiovascular and metabolic profiles, blood pressure, blood pressure control among treated patients, multimorbidity, polypharmacy, and physical performance. Linear and logistic regression models were subsequently applied, adjusting for age, sex, and year of observation. Results The study included 1,657 patients: 1,537 with HIV and 120 without HIV. The non-HIV patients were significantly older (median age 79.8 vs 68.6 years). In the crude analysis, non-HIV patients presented with greater polypharmacy (49.2% vs 22.1%), higher multimorbidity (64.2% vs 33.7%), and lower physical performance. The median Short Physical Performance Battery (SPPB) score was 9 in non-HIV patients and 11 in HIV patients, with an SPPB ≤9 present in 51.3% and 21.1%, respectively. After adjusting for age, sex, and year of observation, no significant differences emerged between the groups regarding polypharmacy, multimorbidity, SPPB scores, systolic blood pressure, or blood pressure control among treated patients (53.3% in non-HIV vs 56.0% in HIV). However, the HIV group exhibited higher triglycerides, lower HDL cholesterol, a greater probability of active smoking (OR 3.62), and a higher likelihood of chronic kidney disease (OR 3.09). This distinct profile was observed despite a lower prevalence of documented prior cardiovascular disease in the HIV cohort (13.6% vs 43.3%; OR 0.39). A sensitivity analysis focused on patients aged 70–89 years substantially confirmed these results. Conclusion In the crude comparison, non-HIV cardiogeriatric patients appear more complex regarding pharmacological burden, multimorbidity, and functional decline; however, they are also substantially older. After adjustments, the two populations are fundamentally similar in terms of pharmacological load, multimorbidity, physical performance, and blood pressure control. Nevertheless, the HIV population maintains a distinct risk profile characterized by higher rates of active smoking, elevated triglycerides, low HDL, and chronic kidney disease.