Chiva Conference: The future of HIV care from the Chair of the British HIV Association (BHIVA)
At the 19th Annual Chiva Conference on 4 April, Prof Yvonne Gilleece, BHIVA Chair, Honorary Clinical Professor, and Consultant in HIV Medicine and Sexual Health (Brighton & Sussex Medical School and University Hospitals Sussex NHS Foundation Trust), presented a forward-looking view on HIV care. Her talk focused on ageing with HIV, treatment advances, prevention strategies, research gaps, future models of care and the global landscape.
Globally, more people over 50 are living with HIV, a trend driven by effective treatments and increased life expectancy. However, transmission rates among older adults have also increased. In the UK, most people with HIV are over 50. In part due to successful vertical transmission prevention, rates remain low among those under 15. As those with HIV age, managing co-morbidities like hypertension, osteoporosis and cardiovascular disease becomes increasingly important.
People with HIV are more likely to experience comorbidities (and a greater number of them) at a younger age. Less is known about co-morbidities among those who live with lifelong HIV. Prof Gilleece discussed the need to explore tools like the modified frailty score and adapt nursing assessments, especially for those with perinatally acquired HIV. It is still unclear whether this group may face age-related health challenges earlier in life.
Advancements in HIV treatment include long-acting injectables, which aim to reduce the frequency of clinic visits. Additionally, she referred to research presented at the Conference on Retroviruses and Opportunistic Infection (CROI) which explored less frequent dosing for oral medications. Excitingly, new data suggests event-based PrEP (Pre-exposure prophylaxis) may be effective for cisgender women, expanding options for HIV prevention.
BHIVA is shifting focus toward preventing co-morbidities rather than solely managing them. For example, prescribing statins to people with HIV from age 40 has significantly reduced cardiovascular-related deaths.
Prof Gilleece raised concerns about under-representation in clinical trials. Despite the disproportionate impact of HIV on people of African descent and cisgender women, trials remain dominated by people of European ancestry and males. This results in data gaps and limited understanding of safety or efficacy in diverse populations. Although more cisgender women are now being included (but remain underrepresented), greater efforts are needed to recruit young people.
On models of care, Prof Gilleece emphasised the need to go beyond viral suppression and support people holistically. This includes stigma-free care, peer support, and services promoting self-management. With an ageing population and a stretched NHS, collaborations between primary, secondary, tertiary, and voluntary care sectors is essential. She mentioned the Brighton & Sussex Silver Clinic as a successful multidisciplinary example bringing together different specialisms and collaboration with a local charity.
During the Q&A, she was asked about moving towards annual clinical appointments. Prof Gilleece noted that annual care may suffice for some, especially those with stable health and no/minimal side effects – an approach validated during the Covid-19 pandemic. However, others may still need regular in-person support, highlighting the importance of patient-centred care.
Prof Gilleece concluded by warning that political shifts – such as USAID and PEPFAR funding cuts – could threaten global HIV progress. The UK must plan its future services within this uncertain context.
Critical Reviewer: Bakita Kasadha, NIHR Doctoral Research Fellow, University of Oxford
