The fact that we are developing guidance centred on the ageing of individuals living with HIV is testament to the success and dedication of scientists, clinicians and patient advocates in getting HIV care to where it is today. Antiretroviral therapy has improved the survival, and thus life expectancy, of those that take it. However, it alone is not sufficient to ensure that all people living with HIV have the opportunity to age well. Barriers to successful ageing include uncontrolled medical comorbidities, frailty, adverse behavioural risk factors and psychosocial problems, including HIV-related stigma and negative socioeconomic circumstances.

Observational studies point to an excess of age-related comorbidities in people living with HIV, occurring in some circumstances at earlier ages than we might see in the general population. Frailty is one such problem, and it may help identify those who are most likely to need enhanced input from health, social and community services.

Frailty, alongside other age-related issues such as falls, mobility decline and cognitive impairment, may be less familiar to those working in HIV services compared to those of us who deal with older adults more regularly in our professional lives. HIV treatment and monitoring guidance is beginning to reflect these issues, yet the supporting ‘how to’ approach is lacking. HIV services have always been adaptable to the changing needs of their users, with some creating pathways or clinics dedicated to age-related issues where there is sufficient user demand or where those living with HIV fall between the gaps of existing frailty services.

There is no one-size-fits-all approach here, and a lack of HIV-specific tools and clinically applicable research means the evidence base is in its infancy. However, frailty has consequences and is potentially reversible, so early identification and intervention is key. Through this document, we have aimed to provide an accessible guide to support and empower those working in HIV to identify and manage individuals living with frailty and HIV. It is by no means exhaustive, but we have tried to signpost to other resources along the way, which you may wish to complement with the help of a friendly local geriatrician!