Background The population infected with HIV is getting older and these people will increasingly develop age-related
non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care
in the Netherlands in the future.
Methods We constructed an individual-based model of the ageing HIV-infected population, which followed patients
on HIV treatment as they age, develop NCDs—including cardiovascular disease (hypertension, hypercholesterolaemia,
myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies—
and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the
national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030.
Findings Our model suggests that the median age of HIV-infected patients on combination antiretroviral therapy
(ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged
50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients
will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more
NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with
20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of
cardiovascular disease and associated drugs. Because of contraindications and drug–drug interactions, in 2030, 40%
of patients could have complications with the currently recommended fi rst-line HIV regimens.
Interpretation The profi le of patients in the Netherlands infected with HIV is changing, with increasing numbers of
older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to
draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure
continued high-quality care. These fi ndings are based on a large dataset of HIV-infected patients in the Netherlands, but
we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a
trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge.