Background <p>Older people living with HIV (PLWH) commonly experience accelerated ageing; however, their subjective experiences of ageing vary substantially among individuals. Self-perceptions of ageing (SPA) is an important psychological factor influencing physical and mental health in older adults, while interoception reflects the ability to perceive and interpret internal bodily signals. To date, the latent heterogeneity of SPA and its relationship with interoception among older PLWH remain unclear. Therefore, this study aimed to identify latent profiles of SPA, examine associated factors, and explore the association between SPA and interoception among older PLWH.</p> Methods <p>A cross-sectional study was conducted from July to December 2025 among 269 older PLWH recruited by convenience sampling from a tertiary hospital in Zunyi. Data were collected using a general information questionnaire, the Brief Ageing Perceptions Questionnaire (B-APQ), the Multidimensional Assessment of Interoceptive Awareness Version 2 (MAIA-2), the FRAIL scale, and the Social Support Rating Scale (SSRS). Latent Profile Analysis was used to identify latent SPA profiles, and multinomial logistic regression was performed to examine factors associated with profile membership. In addition, quantile regression, Restricted Cubic Spline (RCS) regression, and Bayesian factor robustness tests were conducted to evaluate the relationship between SPA and interoception.</p> Results <p>Three latent SPA profiles were identified: low SPA (<i>n</i> = 43, 15.985%), moderate SPA (<i>n</i> = 60, 22.305%), and high SPA (<i>n</i> = 166, 61.710%). Educational level, employment status, personal monthly income, alcohol history, and frailty were significant factors associated with SPA profile membership. Compared with the low SPA group, participants in the high SPA group had significantly lower total interoception scores and lower scores across all interoceptive dimensions (<i>P</i> &lt; 0.001). RCS regression showed a significant non-linear negative association between SPA and interoception (<i>P</i> = 0.023), with a potential threshold at a B-APQ score of 25.55. When SPA scores reached or exceeded this threshold, interoceptive ability declined more markedly. Bayesian factor analysis further supported the robustness of the differences in interoception across SPA profiles.</p> Conclusions <p>SPA among older PLWH shows substantial heterogeneity and is jointly influenced by individual characteristics, behavioral factors, and socioeconomic conditions. SPA was negatively and non-linearly associated with interoception, suggesting that higher levels of negative ageing perceptions may be related to poorer awareness of internal bodily signals. Healthcare providers should implement stratified health management and individualized interventions based on SPA subtypes to improve ageing perceptions and promote healthy ageing among older PLWH.</p> Clinical trial number <p>Not applicable.</p>