Telomere length dynamics in adults living with HIV: A systematic review

Abstract

HIV infection is associated with accelerated biological ageing, with telomere shortening serving as a key biomarker. Although numerous studies have investigated telomere dynamics in people living with HIV (PLWH), results vary depending on study design, population characteristics, treatment exposure, and measurement method. Herein, we summarize existing literature on telomere length (TL) dynamics in PLWH. A comprehensive search for original articles was conducted (07/03/2026) across four databases: PubMed, Scopus, Google Scholar, and ScienceDirect. Studies measuring TL quantitatively in PLWH using validated methods were included. Relevant literature was screened and data on study design, population characteristics, key findings and method of telomere measurement were extracted. A narrative synthesis approach was used to describe trends and study quality was assessed using the GRADE framework. PROSPERO ID: CRD420251241365. Fifty-nine studies met the inclusion criteria. Most (37/59) were cross-sectional, with fewer (13/59) longitudinal studies assessing within-person telomere dynamics. Across studies, HIV infection was associated with shorter TL, although the magnitude of association varied by sex, antiretroviral therapy status, cell type, co-infections, and measurement technique. Telomere attrition appeared more pronounced around the time of seroconversion and in untreated or rapidly progressing individuals. Initiation of antiretroviral therapy (ART) has been associated with partial recovery of TL, although outcomes appear to vary according to regimen type and timing of initiation. Adjustment for potential confounders varied considerably across studies. The available evidence indicates a general association between HIV infection and shorter TL across diverse populations and methodological approaches. However, the predominance of observational and cross-sectional designs limits causal inference and precise characterization of telomere trajectories. While shorter telomeres have been linked to age-related comorbidities in PLWH, their clinical utility as a biomarker remains uncertain. Well-designed longitudinal studies with repeated measurements would allow more precise characterization of individual telomere trajectories across the course of HIV infection and treatment. Not applicable.