What is the measure of success in HIV? The fourth 90: quality of life or healthy aging?

  • Giovanni GuaraldiEmail author
  • Jovana Milic
  • Albert W. Wu
Special Article

Key summary points


The objective of this paper is to critically discuss potential new outcomes to be used as a measure of success for people living with HIV (PLWH) both in clinical and research settings.


This review critically discusses epidemiological, clinical, patient reported and public health outcomes in older adults living with HIV beyond the viro-immunological success. They include health adjusted life expectancy (HALE), frailty, health related quality of life (HRQoL), intrinsic capacity, all of which capture important aspects of the complexity of aging with HIV.


HIV outcomes should go beyond viral undetectability, and be patient-centred.


In the short time frame of 30 years, HIV research has been able to modify AIDS from a rapidly progressive disease leading inevitably to death to a chronic condition. Even more, the health status of people living with HIV (PLWH) has significantly improved reducing the burden of symptoms and improving quality of life (QoL). After introduction of the UNAIDS agenda on the “90–90–90 targets”, it remains unclear what should be the next target in HIV care and research. The objective of this paper is to critically discuss potential new outcomes to be used as a measure of success in PLWH both in clinical and research settings.


To better portray potential outcomes, we will critically discuss epidemiological and clinical outcomes, patient-reported outcomes (PRO), and public health outcomes reported in literature. These outcomes intersect with one another which may suggest contemporary use of different outcomes depending on goals we want to achieve. New outcomes should go beyond undetectability, be patient-centred, and similar to those in geriatric medicine and the general population.


HIV care can take advantage of experience from geriatric medicine and teach-back by describing aging trajectories in PLWH that may be accentuated in comparison to general population. However, we still need to improve tools to measure quality of life, PROs, and healthy aging. Healthy aging assessment will allow us to recognize unmet needs in PLWH and represents an integrated model between community, the person, and healthcare providers, wherein all stakeholders are linked, increasing possibilities for effective intervention.


Quality of life Healthy aging Measure of success Patient related outcomes Intrinsic capacity Frailty 



There was no dedicated funding for this study.

Compliance with ethical standards

Conflict of interest

All other authors report no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  • Giovanni Guaraldi
    • 1
    • 4
    Email author
  • Jovana Milic
    • 2
  • Albert W. Wu
    • 3
  1. 1.Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative MedicineUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Medicine and Medical Specialties, Infectious Diseases Clinic, School of MedicineUniversity of Modena and Reggio EmiliaModenaItaly

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