Abstract To explore differences among the elderly people (aged over 50 years old) living with HIV (PLWH) who are receiving antiretroviral therapy (ART), we collected and analyzed data using cross-sectional research methods. Among 520 elderly PLWH on ART, those over 60 years old, compared to those aged 50–60, had lower levels of education, more retirees in occupation distribution, a lower rate of active consultation, a higher proportion of heterosexual transmission, and more complications. Additionally, this study demonstrated a greater incidence of severe disease symptoms and a higher rate of ART failure. These findings underscore the importance of prioritizing targeted nursing care and interventions for elderly PLWH in future healthcare strategies.