How Long Does It Take for HIV to Turn Into AIDS?

If left untreated, human immunodeficiency virus (HIV) almost always will progress to AIDS, even after many years. The immune defenses become compromised and the body is less able to defend itself against life-threatening infections, though the timelines may vary with the individual.

On average, without antiretroviral medications (ART), chronic HIV will progress to AIDS in five to 10 years, though it may be faster in some people. That said, there are now 39 million people living with HIV globally and, in many nations, the infection can be managed as a chronic disease.

Factors Affecting HIV Progression

Generally speaking, the time it takes to go from HIV infection to AIDS is around five to 10 years if no medical intervention is made. Some people will develop AIDS faster or slower, depending on factors that include:

• The mode of HIV transmission (sexual activity more likely leads to faster progression than blood transfusion)
• Age at diagnosis (older adults are more at risk of faster progression than younger)
• The place where the person is tested (faster progression when tested at a hospital, possibly because they are receiving care for a separate condition or it's a late-stage HIV diagnosis)
• Higher CD4 T-cell counts (a key measure of immune cells in HIV/AIDS)

Other factors may be at work, too. They include education level, mental health challenges, social and family support, or stigma affecting men who have sex with men (MSM). With MSM, for example, the impacts may be due to delays in or access to care, but some studies suggest there also may be exposure to more virulent strains, or immune system stress due to anxiety and lack of support.

A person's genetic history, or the genetic strain of HIV involved with infection, also affects AIDS progression.

Stages of HIV Infection

The stages of infection from person to person vary slightly, both in severity and the speed of progression. These stages map the depletion of CD4 T-cells and other evidence of illness.

With each progression, the risk of opportunistic infections (OIs) increases until the immune system is said to be fully compromised. It is at this stage that the risk of life-threatening illness and death are high. Stages of infection include:

• Acute infection: Many people can have fever, headache, a rash, and flu-like symptoms. Fatigue, swollen tonsils, sore throat, and diarrhea are common. Symptoms emerge in about two to four weeks. The viral load is high, and there's a high risk of HIV transmission in this stage.
• Chronic infection: After the initial infection has been controlled by the immune system, the virus hides in the body. This chronic (or latent) stage of infection can last for years.
• AIDS: The stage is technically classified as having either an AIDS-defining condition or a CD4 count of under 200 cells/milliliter. Without treatment, people usually live about three years with AIDS.

Treating HIV Infection

Antiretroviral drugs are the mainstay of HIV treatment, although not all medications are as effective for HIV-2 strains as they are for HIV-1, which has long been the target of drug development.

With ART, people living with HIV can experience normal to near-normal lifespans and limit the chance of transmitting the infection to zero. The Food and Drug Administration has approved:

• Nucleoside reverse transcriptase inhibitors (NRTIs) like Viread (tenofovir DF)
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) like Sustiva (efavirenz)
• Protease inhibitors like Lexiva (fosamprenavir)
• Fusion inhibitors such as Selzentry (maraviroc)
• Integrase inhibitors such as Isentress (raltegravir)
• Attachment inhibitors such as Rukobia (fostemsavir)
• Post-attachment inhibitors such as Trogarzo (ibalizumab)
• Capsid inhibitors, like the comparatively new Sunlenca (lenacapavir)

A number of combination medications, as well as drugs meant to make another HIV medication more effective, are also approved for HIV treatment.

Drugs used for prevention include pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). They don't treat HIV but are designed to limit risk in people who may be exposed to HIV.

Summary

In most people, HIV will progress to AIDS within five to 10 years without treatment. There are people who experience rapid progression within three to five years, and there are others who remain symptom-free for 10 years or more.

Treatment, however, has changed expectations about HIV infection. Most people who receive ART medications can expect to have a normal or near-normal life expectancy, although prognosis depends on age, HIV strain, access to care, and other factors. Talk with your healthcare provider about HIV diagnosis and treatment options.