PROGRESS

Some people with HIV are starting to live as long as people without it

Although HIV hasn’t be an immediate death sentence for a long time thanks to medications like antiretroviral therapy, those who are diagnosed still typically died younger than the general population.

This is because even without developing full-blown AIDS—the permanent condition of having a compromised immune system because of the HIV virus—carrying the virus ages, even at manageable levels, ages cells prematurely, and the medication to manage HIV itself is rather toxic. Back in 1996, with three years of antiretroviral therapy, a 20-year-old male HIV patient in Europe or North America could only be expected to live until his mid 60s; a woman would be expected to live until her late 60s.

But now, the prognosis is much better, to the point where people living with HIV are able to live almost as long as folks without it. In a review published in The Lancet HIV, researchers from the Antiretroviral Therapy Cohort Collaboration—a group based out of the University of Bristol in England—found that on average, European and North American men and women living with HIV are living to 73 for men and 76 for women, if they began treatment between 2008 and 2010. The average life expectancy in the US is currently 79 years on average, or just under 77 for men and just over 81 for women.

The authors of the new research examined the results of 18 studies about patients living with HIV in Europe and North America. They considered factors like how much of the virus was present (lower is better) and CD4 white blood cell count (higher is better), which are typically used to measure the severity of the infection. These measures improved in patients who began treatment in cohort groups that started treatment later. The real difference seems to come from medications that have been less harmful over time, and better adherence to taking them.

But patients living with HIV may face other complications, cautions Scott Turner, a neurologist at Georgetown University who studies HIV and is unaffiliated with the new research. For example, he says, “since aging is a major risk factor for HIV-associated neurocognitive disorder (HAND), we may expect to see a parallel increase in HAND in coming years.” Turner has treated several patients who have lived with HIV long enough to develop Alzheimer’s—although they may have presented it earlier than normal as a result of the HIV virus and treatment.

The huge variance in life expectancy across countries like the United States, where there can be as much as a 20-year gap depending on where in America a person was born, effectively means that patients in areas with the longest life spans may outlive people living without HIV in other areas.

But living with HIV requires a lot of constant care—regular doctor’s visits to manage prescriptions and early intervention for other chronic conditions—and not everyone with HIV has access to consistent, high-quality care. Minorities and people in lower socioeconomic brackets tend to experience disproportionately higher rates of HIV, and have worse access to healthcare.

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