Comorbidities often appear earlier and progress faster in PLHIV.  Vascular risk factors such as smoking, hypertension, diabetes, hypercholesterolaemia and hyperlipidaemia should be considered, as they would in the non-HIV population. Other considerations include impaired renal function, cytomegalovirus, frailty, chronic pulmonary disease; the gut biome may also be involved (4,35).