4 Habits That Can Erase the Benefits of HIV Therapy

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Calculating the Loss of Life Years

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It has been well established that the early diagnosis and treatment of HIV can increase life expectancy that to the general population.

In fact, research from the Multicenter AIDS Cohort Study (MAC) has concluded that a person starting antiretroviral therapy (ART) at CD4 counts above 350 cells/µL could very well have a lifespan equal to or even greater than that of a non-infected individual.In the U.S., that translates to a life expectancy of roughly 76 years for men and 81 years for women.

The irony today is that, while ART correlates to profound gains in life years, everyday habits and decisions we make can take back many—if not all—of those gains.

What follows are the 4 habits that can reduce your lifespan by as much as 15 years, as well as the steps you can take to reverse those losses if you have HIV.

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Poor Drug Adherence - Loss of 10 Years

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Missing an occasional dose of your HIV medicines is only human. Doing so habitually is another matter entirely, impacting not only the efficacy of your drugs but the very course of your disease.

While antiretroviral therapies are far simpler today than ever—with fewer pills, lesser side effects, and easier dosing schedules—as few as 60% of those on therapy are able to maintain the levels of adherence needed to fully suppress the virus. By failing to sustain an undetectable viral load, patients are more likely to experience treatment failure as they become increasingly resistant to their HIV drugs. As a result, valuable treatment options are lost, often forever.

Treatment failure is most often associated with poor drug adherence, even among those with extremely low viral activity. Research from McGill University in Montreal has suggested that patients with "near-detectable" viral loads (i.e., between 50 and 199 copies/mL) have a 400% greater risk of treatment failure than those with sustained and complete viral suppression. 

In 2015, the UK Collaborative HIV Cohort (UK CHIC) Study looked into the impact of viral suppression on a person’s life expectancy and concluded that a 35-year-old man unable to achieve an undetectable viral load while on ART could expect to lose 10 years of life expectancy, even if the CD4 count were above 350 cells/µL.

Here is a list of some of our favorite drug adherence tips designed to provide you the tools for self-efficacy over the long term.

Sources:

Laprise, C.; de Pokomandy, A.; Baril, J.; et al. "Virologic failure following persistent low-level viremia in a cohort of HIV-positive patients: results from 12 years of observation."Clinical Infectious Diseases.November 2013; 57(10):1489-96.

May, M.; Gompels, M.; Delpech, V.; et al. "Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy." AIDS. May 15, 2014; 28(8):1193-1202.

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Injecting Drug Use - Loss of 11 Years

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Injecting drug use is not only associated with the greater risk of acquiring HIV and hepatitis C, it can increase the likelihood of death as a result of an AIDS-related infection even among those able to achieve viral suppression.

A study from the British Columbia Centre for Excellence in HIV/AIDS in Vancouver examined life expectancy rates in 2,637 HIV-positive injecting drug users (IDUs) over the age of 20, collecting the time and causes of death of the 200 participants who had died over the course of  a seven-year period.

While overdose and suicide accounted for 19% of deaths, HIV and associated infections accounted for the majority overall, correlating to a loss of just over 11 years of life irrespective of treatment status.

A similar study from Tufts-New England Medical Center also looked at 656 IDUs over a five-year period and concluded that the majority of deaths among HIV-positive users (66%) were attributed to HIV or an associated infection, while a little more than a third were related directly to substance abuse or violence.

To find a treatment program nearest you, visit the About.com directory of substance abuse treatment centers.

Sources:

Lloyd, Smith, E.; Brodkin, E.; Wood, E.; et al. "Impact of HAART and injection drug use on life expectancy of two HIV-positive cohorts in British Columbia." AIDS.  February 14, 2006; 20(3):445-450.

Kohli, R.; Lo, Y.; Howard, A.; et al. "Mortality in an Urban Cohort of HIV-Infected and At-Risk Drug Users in the Era of Highly Active Antiretroviral Therapy." Clinical Infectious Diseases. 2005; 41(6):864-872.

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Smoking - Loss of 12 Years

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Mirøslav Hristøff

Smoking, as an independent factor, is considered to have the far greatest impact on morbidity and death in people with HIV than any other HIV- or non-HIV-related disease.

What make this all the more distressing is the fact that people with HIV are twice as likely to smoke than non-infected individuals and tend to develop smoking-related illnesses 10-15 years earlier overall.

A 2013 study from Copenhagen University Hospital reported that smoking, in and of itself, reduces life expectancy by an average of 12 years in people with HIV—doubling the risk of acute heart disease, doubling the risk of death from chronic obstructive pulmonary disease (COPD), and increasing the risk of lung cancer by a staggering 1400% when compared to the general population.

By contrast, smoking cessation among people with HIV is associated with a 65% reduction in heart disease risk after just three years, as well as a 50% drop in lung cancer risk after only one year.

Sources

Helleberg M.; Afzal, S.; Kronborg, G.; et al. "Mortality attributable to smoking among HIV-1-infected individuals: a nationwide population-based cohort study."Clinical Infectious Diseases.March 2013; 56(5): 723-734.

Clifford G.; Lise, M.; Franceschi, S.; et al."Lung cancer in the Swiss HIV cohort study: role of smoking, immunodeficiency and pulmonary infection."British Journal of Cancer. January 12, 2012; 106(3): 447-452.

Petoumenos, K.; Worm, S.; Reiss, P.; et al. "Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study(*)."HIV Medicine. August 2011; 12(7):214-421.

Thiébaut, R.; Aurillac-Lavignolle, V.; Bonnet, F.; et al. "Change in atherosclerosis progression in HIV infected patients: ANRS Aquitaine Cohort, 1999-2005."AIDS.2005; 19 (7): 729-731.

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Delaying HIV Therapy - Loss of 15 Years

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Artwork © Alan Cleaver

Procrastination and avoidance are two habits a person with HIV cannot afford to indulge in, particularly when it comes to HIV therapy. By delaying treatment for years and even decades, you allow the virus to needlessly deplete your immune system, while submitting your body to years of inflammation that can lead to the premature development of aging-associated illnesses

Researcher from the UK CHIC Study concluded that a person who delays treatment until his or her CD4 count drops below 350 cells/µL can expect to live 15 years less than a person who starts above 350 cells/µL.

On the flip side, starting therapy at the time of diagnosis, irrespective of CD4 count, not only increases the likelihood of a normal life expectancy but reduces the risk of HIV- and non-HIV-associated diseases by 53%.

Sources:

May, M.; Gompels, M.; Delpech, V.; et al. "Impact of Late Diagnosis and Treatment on Life Expectancy in People With HIV-1." British Medical Journal. October 11, 2011; 343:d6016.

The INSIGHT START Study Group. "Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection."New England Journal of Medicine. July 20, 2015; DOI: 10.1056/NEJMoa1506816.

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