What is the Measure of Success in HIV? The Fourth 90: Quality of Life or Healthy Aging?

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. METHODS: 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. CONCLUSIONS: 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.