Question: How long can I expect to live after getting HIV?
Answer: The answer is both simple and not-so-simple. By and large, the outlook is extremely positive. With the proven effectiveness of combination antiretroviral therapy (cART), people with HIV can today expect to live longer and healthier than ever
- if infection is detected and treated early (before immune function is compromised) and;
- if they are able to ensure viral suppression by maintaining life-long adherence once therapy started.
To some, that may seem like a lot of "if's."
But the truth is that HIV is a very different disease than it was 10 years ago. Maintaining adherence is easier today with drugs that offer lower pill burdens, less side effects, and far superior drug resistance profiles to previous-generation drugs.
Because of this, a 20-year-old HIV-positive individual on cART in the U.S. and Canada can now expect to live into his or her early 70s, according to data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).
In fact, according to a 2014 update by the Multicenter AIDS Cohort Study (MACS), people with HIV who start cART at CD4 counts above 350 cells/mL may be able to have a life expectancy equal to or even greater than that of the general population.
But that, of course, brings us back to all of those "if's."
The Impact of HIV Comorbidities on Longevity
Ultimately, longevity can only be determined by the cumulative factors that 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 economic status).
Furthermore, the proper treatment and management of HIV is only part of the game. Even for people able to maintain full viral suppression, the risk for the development of non-HIV-related comorbidities, such as cancer or heart disease, is far greater that of the general population, and generally develops 10 years earlier than people who don't have HIV.
So profound are these concerns that, in the developed world, a person living with HIV is far more likely to die prematurely of a comorbid condition than an HIV-related one.
Therefore, proactively addressing both HIV-related and non-HIV-related health issues is vital in ensuring not only long life, but long quality of life in people with HIV.
Factors That Can Influence Life Expectancy in People with HIV
Factors that influence life expectancy are generally considered either static (or fixed) or dynamic (able to change or fluctuate over a short period of time).
Static factors, like race or sexual orientation, influence life expectancy not so much because a person is either white or African American, or identifies as gay or heterosexual. Rather, longevity is associated with a multitude of risk factors within these specific population groups.
For instance, high levels of poverty in African American communities (24.9%) and the consequential lack of access to healthcare negatively impacts the survival rate when compared to white population. Conversely, stigma reduction and access to community-specific HIV care may be contribute to the higher survival rates among men who have sex with men (MSM).
Dynamic factors, on the hand, generally have very strong causal effects insofar as survival time is concerned. Some of these, like treatment adherence, relate specifically to the preservation or deterioration of a person's immune function. Others, like smoking, contribute to the premature development of non-HIV-related comorbidities, such lung cancer. Still others, like injection drug use, are affected both fronts—both behavioral vulnerability and a person's vulnerability to infection.
Among the key findings:
- CD4 count at the time of cART initiation remains one of the strongest indicators of life expectancy. Starting therapy at a CD4 count below 350 cells/ µL correlates to a quantitative reduction in life-years. Simply put, as the CD4 continues to dip beneath the 350 threshold, so, too, does life expectancy—by as much as 22 years, according to an analysis of the NA-ACCORD study data.
- HIV-infected smokers lose more life-years to smoking than to HIV, say researchers from Department of Infectious Diseases at the University at Copenhagen. In fact, the risk of death from smoking is twice as high among smokers with HIV than those without. When compared to non-smoking people with HIV, smokers with HIV trim as much as 12 years from their lives, reducing life expectancy to just under 63 years.
- Race and HIV longevity are integrally linked. Quite simply, HIV-positive non-whites live, on average, 8.5 year less than their white counterparts. That's a 15% difference, with the lowest life expectancy seen among African-Americans.
- Injection drug users (IDUs) suffer from substantially increased mortality, both in terms of HIV-related infections and non-HIV-related comorbidities (like liver cancer). According to a collaborative cohort study of 6,269 IDUs in North America and Europe, the strongest contributing factors to lower life expectancy rates were treatment adherence and hepatitis C (HCV) co-infections. All told, life expectancy for IDUs is 20 (or more) years less than all other HIV groups.
Meanwhile, most research indicates that gender has no impact whatsoever on either disease progression or mortality. Moreover, white MSM are seen to have among the longest life expectancy of all HIV groups.
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.
United Nation Department of Economic and Social Affairs (UN DESA), Population Division. "World Population Prospects: The 2012 Revision, Key Findings and Advance Tables." Released June 13, 2013; Working Paper No. ESA/P/WP.227.
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.
United States Census Bureau. "Income, Poverty and Health Insurance Coverage in the United States: 2011." U.S Department of Commerce. September 12, 2012; Reference CB12-172.
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