Non-communicable disease burden among middle-aged and older adults living with HIV in the Western Pacific region: A systematic review and meta-analysis

Objective: Middle-aged and older adults living with HIV in the Western Pacific Region (WPR) are experiencing accelerated aging and a rising burden of non-communicable disease (NCD)-related comorbidities. This systematic review and meta-analysis aimed to assess the burden of major NCDs—measured by prevalence, incidence, and mortality—among people living with HIV(PLWH) aged 40 years and older, in comparison to their HIV-negative counterparts. Methods: A comprehensive literature search was conducted across Medline (1966-), Embase (1974-), Cochrane Library (1996-), Epistemonikos (established in 2012, with retrospective coverage), and Web of Science (1900-) to identify relevant studies published up to May 9, 2025. Meta-analyses limited to NCD categories with three or more comparable studies. Random-effects was performed using MetaXL software. Results: Nineteen articles were included, and the majority reported prevalence estimates (13/19 studies). Our findings indicated pooled prevalence ratio estimates for cardiovascular diseases (1.17, [95 % confidence interval: 0.97–1.42]), cancers (1.23 [1.05–1.45]), diabetes (1.64 [1.19–2.27]), kidney diseases (2.26 [1.03–4.97]), chronic respiratory diseases (2.13 [0.82–5.53]) and mental illnesses (2.25 [1.82–2.78]). Subgroup analysis indicated a significantly high prevalence of depression (3.00 [2.17–4.16]). The pooled incident rate ratio for cancers was 3.99 (2.33–6.84) per 1000 person-years. Conclusions: In the WPR, middle-aged and older adults living with HIV face an elevated burden of cancers, diabetes, kidney disorders, and mental health conditions. There is an urgent need to develop care strategies tailored to the specific needs of diverse populations, and further research is required to support the management of chronic respiratory diseases.