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The lead author, a geriatrician, and her colleagues make a strong case in a recent IAS journal publication that geriatric approaches used with very old persons should be adapted and applied to the care of older adults with HIV. The high frequency of multimorbidity and associated polypharmacy found in the older adult with HIV supports this view. “Comprehensive Geriatric Assessment” (CGA) is commonly used by geriatricians. It assesses medical, social, functional, psychiatric, and other domains. The CGA provides a more comprehensive picture of needs of the older adult with HIV. The CGA is also coupled with assessment of instrumental activities of daily living, cognitive status, and the presence of depressive symptoms. The article provides examples of how this approach might be incorporated into care delivery. One model utilizes a consultative mechanism. Examples are provided from multiple locations in the United States and internationally. A second model approaches the problem by building on established metabolic clinics that have been treating older adults with HIV while embracing a more comprehensive approach to health management. The challenge to such strategies is the stark reality of limited financing, insufficient support from leadership, lack of geriatric expertise, and uncertainly about the research base for actualizing these programs. The authors make a plea for developing a mechanism to share approaches and experiences to better address the needs of older adults with HIV.