Abstract
BACKGROUND: Life expectancy in people with haemophilia (PWH) has risen markedly, creating an ageing population with both age-related diseases and sequelae of historical treatment eras. Chronic hepatitis C virus (HCV) and HIV infections still influence long-term outcomes despite effective antiviral therapy, while decades without or with insufficient prophylaxis left many PWH with joint damage, pain, and functional restrictions. With age, cardiovascular, metabolic, and psychological comorbidities have become increasingly relevant. SUMMARY: Older PWH present with a diverse comorbidity profile shaped by factors specific to them, such as historical viral exposures and longstanding arthropathy, and by those prevalent in the ageing general population. Chronic arthropathy remains a central driver of disability, contributing to reduced mobility, osteoporosis, and fracture risk. Cardiovascular disease is increasingly relevant, with high rates of hypertension and age-typical atherosclerosis, while managing acute coronary syndromes and atrial fibrillation requires balancing standard cardiology care with haemostatic support. Obesity, diabetes, and most cancers occur at frequencies similar to the general population and cluster with other cardiovascular risk factors. Psychological symptoms, including depression and anxiety, are common and linked to chronic pain, declining independence and social isolation. Future cohorts receiving early prophylaxis or non-factor therapies are expected to age with less joint morbidity, although the vascular impact of newer agents remains uncertain. KEY MESSAGES: Ageing PWH faces both haemophilia-specific sequelae and age-related comorbidities. Musculoskeletal impairment, cardiovascular and metabolic disorders, and psychological symptoms now shape morbidity. Historical effects of HCV and HIV persist, and evolving therapies will influence future patterns, requiring sustained multidisciplinary care.