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Background: Treatment priorities or needs may change in older people living with HIV (PLHIV) after years of HIV treatment and comorbidities. We explored unmet needs of older PLHIV (≥50 y) and compared shift in treatment priorities over time in older vs younger PLHIV. Methods: 230 PLHIV aged ≥18 y on antiretroviral therapy (ART) completed the 2019 Positive Perspectives survey from Taiwan, Japan, China, and South Korea. PLHIV diagnosed for ≥1 y were asked what was most important when they started ART vs. current priorities. Age-stratified prevalence estimates were compared with χ 2 tests. Results: Comorbidity prevalence was higher in PLHIV ≥50 y (86%, 43/50) vs. <50 y (60%, 108/180; p=0.001). Of PLHIV ≥50 y, 42% (21/50) believed HIV will reduce their lifespan while 52% (26/50) felt HIV negatively impacted their life. Reasons for missing ART in PLHIV ≥50 y included wanting to forget about HIV, depression, and being bored of daily dosing. Older adults were more open to taking ART with fewer medicines vs. younger adults (80%, 40/50 vs. 61%, 110/180; p=0.013). For all PLHIV, a key treatment priority more important now vs. at ART start was reducing risk of long-term negative effects. This priority was 7-fold greater in older adults (22-percentage point increase between time of ART start vs. now, 26% vs. 48%) than younger adults (3-percentage point increase, 47% vs. 50%). Older adults were more confident about their current ART and more trusting of providers: 38% were worried about running out of treatment options (19/50) vs. 55% (99/180) of those <50 y (p=0.033). Only 20% (10/50) of PLHIV ≥50 y would not discuss treatment concerns with their provider because they felt little could be done to help vs. 37% (66/180) of those <50 y (p=0.027). Conclusion: Treatments with lower risk of long-term negative impacts were a key priority for older adults. Treatment planning should strive to meet patients’ preferences to enhance their well-being and strengthen their relationship with providers. [ABSTRACT FROM AUTHOR]