Human Immunodeficiency Virus (HIV) was once a diagnosis associated with profound fear and limited life expectancy. However, significant advancements in medical understanding and treatment have transformed HIV into a manageable, chronic health condition.
Dramatic Shift in Survival
Before 1996, an HIV diagnosis often meant a severely shortened lifespan. Without effective treatments, individuals typically lived only 1 to 2 years after an AIDS diagnosis. A 20-year-old diagnosed with HIV in 1996 could expect to live only until around age 39. This grim prognosis was due to the virus’s unchecked destruction of the immune system, leaving individuals vulnerable to opportunistic infections and certain cancers.
The introduction of highly active antiretroviral therapy (HAART) in 1996 marked a profound turning point. ART involves combination therapies that target the virus at multiple stages of its life cycle, preventing it from replicating effectively. The widespread adoption of ART led to a dramatic reduction in AIDS-related deaths and a significant increase in survival rates.
Modern Life Expectancy with Treatment
Today, for individuals diagnosed early and consistently adhering to ART, life expectancy is comparable to that of the general population. A study of people who started ART after 2015 with a high CD4 count (above 500) found life expectancy similar to the general population—77 years for men and 79 for women in Europe and the US. Other data from 2013 indicated a 20-year-old starting ART could expect to live into their early 70s.
ART works by suppressing the HIV virus, reducing the viral load. HIV medicines prevent the virus from multiplying, allowing the immune system’s CD4 T-cells to recover. This restoration of immune function helps the body fight off infections.
Achieving an “undetectable” viral load is a primary goal of ART. An undetectable viral load means the amount of HIV in the blood is so low that standard laboratory tests cannot detect it. When a person living with HIV maintains an undetectable viral load for at least six months, they cannot sexually transmit the virus to others. This concept is “Undetectable = Untransmittable” (U=U), emphasizing its role in improving individual health and preventing transmission.
Factors Influencing Long-Term Well-being
While ART has improved HIV management, several factors influence an individual’s long-term health outcomes. Early diagnosis and prompt initiation of treatment are important. Starting ART when the immune system is stronger, with a higher CD4+ T-cell count, leads to better long-term health and reduces the risk of disease progression. Delayed diagnosis often results in lower CD4 counts and higher viral loads, which can negatively impact health and increase transmission risk.
Consistent adherence to medication is another factor for successful HIV management. Taking ART exactly as prescribed ensures the drugs control the virus. Poor adherence can lead to the virus multiplying, increasing the risk of drug resistance and treatment failure. Regular medical follow-ups are also important to monitor viral load and CD4 counts, allowing healthcare providers to adjust treatment and address any emerging health concerns.
People living with HIV may experience a higher risk for co-existing health conditions, such as cardiovascular disease, certain cancers, diabetes, and kidney disease, even with effective ART. These comorbidities can be influenced by chronic inflammation caused by HIV and the long-term effects of some medications. Managing these conditions through regular screenings and medical interventions is important.
Lifestyle choices also play a role in long-term well-being. Eating a balanced diet, engaging in regular physical activity, and avoiding smoking and excessive alcohol or drug use can support immune function, reduce the risk of other chronic diseases, and improve mental health. Smoking, for example, is associated with a higher risk of various health problems in people with HIV, potentially reducing life expectancy. Addressing mental health, managing stress, and maintaining strong social connections contribute to a higher quality of life.