The availability of potent antiretroviral therapy (ART) has transformed the HIV epidemic, changing HIV disease from a fatal illness to a chronic, manageable condition. In higher income countries, life expectancy for people living with HIV(PLWH) has increased substantially, nearing that of the general population, and similar gains have been seen in some parts of sub-Saharan Africa, the area of the world most impacted by HIV. Although access to ART is far from universal, substantial progress has been made in reaching the UNAIDS 90–90–90 targets, that is, that 90% of all PLWH in a community or a country are aware of their status, 90% of those aware have initiated ART, and 90% of those on ART achieve durable viral suppression. The median age of PLWH is expected to increase as the scale-up of HIV treatment continues, with more and more PLWH garnering the survival benefits from treatment. Older adults are also at risk of HIV acquisition and they are rarely prioritized for HIV prevention or testing efforts. The resultant ‘greying of the HIV epidemic’ raises important questions regarding understanding the effect of aging on PLWH, the effect of HIV infection on the aging process, and optimal approaches to HIV prevention among older individuals. Thus, a critical priority is to aim for healthy aging among PLWH, an achievement that some have called ‘the 4th 90’.