How Long Can I Live If I Get HIV?

Normal life spans are achievable but challenges remain

Doctor talking to patient.
PeopleImages/E+/Getty Images

It is a natural response to wonder how long you have to live if you have HIV. While people will assure you that it's a treatable disease, what does that actually mean in terms of not only life span but a person's quality of life?

The answer is both simple and not-so-simple. By and large, the outlook is extremely positive. With the proven effectiveness of antiretroviral therapy, people with HIV can today expect to live longer and healthier than ever if:

  • Infection is diagnosed and treated early before the immune system is compromised.
  • The person is able to sustain an undetectable viral load by ensuring lifelong adherence to treatment.

To some, that may seem like a lot of "if's.

The simple truth is that HIV is a very different disease than it was 10 years ago. Maintaining adherence is far easier with therapies that offer fewer side effects, easier dosing, and a far lower risk of drug resistance than ever before.

Because of this, a 20-year-old HIV-positive person on treatment can expect to live into his or her early 70s, according to a study from the long-running North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

A 2014 update by the Multicenter AIDS Cohort Study further supported those claims, suggesting that people who start treatment early (at CD4 counts over 350) may be able to achieve a life expectancy equal to or even greater than that of the general population.

Even in some of the harder hits parts of Africa, life expectancy has approached near-normal levels due to the widespread distribution of HIV medications.

From that perspective, everything seems rosy. Until, of course, we get back to those "if's."

Factors That Influence Life Expectancy

From an individual standpoint, longevity is subject to numerous, interconnected factors that can either increase or decrease life expectancy in a person with HIV.

These factors range from things we can control (such as treatment adherence or lifestyle choices) to things we can't (such as race or income status).

Furthermore, the treatment and management of HIV is only part of the game. Even for people able to maintain an undetectable viral load, the risk for the non-HIV-associated diseases, like cancer or heart disease, is far greater than in the general population and occurs 10 to 15 years earlier.

So profound are these concerns that, in the developed world, a person with HIV is far more likely to die prematurely of a non-HIV-related illness than an HIV-related one. For this reason, people with HIV need to address both HIV- and non-HIV-related health risks if we are to live a normal life span.

Gains and Losses in Life Years

Factors that influence life expectancy are considered either static (fixed) or dynamic (able to change or fluctuate over time).

Static factors, like race or sexual orientation, influence life expectancy because they are linked to a multitude of risk factors that a person is often unable to escape. For example, high levels of poverty in African American communities combined with a lack of access to health care and high levels of HIV stigma take back many of the gains seen in white communities.

Add to that the stigmatization of homosexuality and you're left with what we have today: a 50/50 lifetime risk of HIV among African American gay and bisexual men.

Dynamic factors, by comparison, have a strong causal and effect relationship to survival times. Things treatment adherence can directly impact disease progression. Multiple sex partners not only increase your risk of infection but can lead to comorbid conditions, like hepatitis C, which can further whittle away life year.

When looking at both static and dynamic risk factors, we can begin to identify where we can gain years and lose life-years without even knowing it.

For example:

  • A person's CD4 count at the start of treatment remains one of the strongest indicators of life expectancy. Starting therapy when the CD4 count is below 200 corresponds to as much as a 22-year loss in life expectancy.
  • Smokers with HIV lose more life-years to smoking than to HIV. In fact, the risk of death from smoking is twice as high among smokers with HIV and can trim as much as 12 years a person's life span irrespective of HIV.
  • Race and longevity are integrally linked in HIV. According to research, HIV-positive non-whites live an average of 8.5 years less than their white counterparts.
  • Injecting drug users suffer losses, both in terms of HIV-and non-HIV-related illnesses (like liver cancer). The strongest contributing factors were poor treatment adherence and hepatitis C co-infections. All told, life expectancy for injecting drug users is 20 years less than all other HIV groups.

In the end,it's important to remember that statistics are not a prognosis. They cannot predict what will happen during the course of an individual infection. They can only suggest what you steps you can take to minimize risk of illness based on the factors you and your doctor can readily change,

Sources:

Hogg, R.; Althoff, K.; Samji, H.; et al. "Increases in life expectancy among treated HIV-positive individuals in the United States and Canada, 2000-2007." 7th International AIDS Society (IAS) Conference on Pathogenesis, Treatment, and Prevention. Kuala Lumpur, Malaysia. June 30-July 3, 2013; Abstract TUPE260.

Hasse, B,; Ledergerber, B.; Egger, M., et al. "Aging and (Non-HIV-associated) Co-morbidity in HIV-positive Persons: The Swiss Cohort Study (SHCS)." 18th Conference on Retroviruses and Opportunistic Infections, Boston. Abstract 792, 2011.

Thorsteinsson, K.; Ladelund, S.; Jensen-Fangel, S.; et al. "Impact of gender on the risk of AIDS-defining illnesses and mortality in Danish HIV-1-infected patients: a nationwide cohort study." Scandinavia Journal of Infectious Disease. October 2012; 44(10):766-75.

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):727-34.

Murray, M.; Hogg, R.; Lima, V.; et al. "The Effect of Injecting Drug Use History on Disease Progression and Death Among HIV-positive Individuals Initiating Combination Antiretroviral Therapy." HIV Medicine. February 2012; 13(2):89-97.

Continue Reading