Abstract
A BSTRACT Antiretroviral therapy (ART) has transformed human immunodeficiency virus (HIV) infection into a manageable chronic disease, yet virological suppression alone does not fully resolve immune dysregulation, chronic inflammation, or tissue stress. Older adults with HIV experience multimorbidity, frailty, polypharmacy, and drug–drug interaction risk, all of which may destabilize adherence and longer-term recovery. This narrative review synthesizes literature linking ART adherence, clinical pharmacy interventions, and biological pathways potentially relevant to broader recovery in HIV. In this review, the term “regenerative outcomes” is used as an operational, nonstandard term to denote immune reconstitution, reduction in chronic inflammation, preservation of tissue homeostasis, mitigation of drug toxicity and resistance, and maintenance of functional health. The available evidence base is small and heterogeneous: eight core studies met the inclusion criteria, supplemented by contextual and mechanistic literature. Across adherence-centered and optimization studies, sustained ART exposure was associated with viral suppression, CD4+ T-cell recovery, and therapeutic success. Switch studies suggest that regimen optimization can maintain suppression while preserving CD4 trajectories and selected inflammatory profiles. Reviews of aging with HIV highlight the importance of medication review, simplification, stewardship, and drug–drug interaction management in the setting of multimorbidity and polypharmacy. Direct evidence linking pharmacist-led interventions to biological endpoints remains limited, and no study has directly demonstrated an effect on regenerative biomarkers. Accordingly, the proposed links between clinical pharmacy and biological recovery should be interpreted as conceptual and hypothesis-generating rather than causal. Future studies should integrate pharmacy-led care with immune, inflammatory, tissue-health, and functional endpoints.