DNA methylation patterns in blood samples from 216 HIV patients with well-controlled infections revealed that specific epigenetic aging clocks can predict serious health outcomes over 10 years of follow-up. The GrimAge V1-V2 clock showed the strongest association, with accelerated epigenetic aging linked to a 4-fold increase in all-cause mortality risk. PC-GrimAge and Hannum's clock predicted more than double the risk of serious non-AIDS events, while Horvath's clock was associated with 50% higher risk of aging-related conditions. Remarkably, all 17 patients who died had baseline DunedinPACE values above 1, suggesting this biomarker might serve as a mortality screening tool. This represents a significant advancement in personalized HIV care, as traditional viral load and CD4 counts don't capture the accelerated aging processes that affect long-term prognosis in this population. The findings could transform clinical monitoring by identifying high-risk patients years before symptoms appear, enabling early interventions for age-related complications. However, the relatively small cohort size and preliminary nature of the study necessitate validation in larger, more diverse populations before clinical implementation.