By Squirrel Brother, Squirrel’s Little Cabin
August 30, 2024, 19:36

Recently, a popular science article on how long people with HIV can live was published on Verywell Health. The article summarizes that with proper treatment, people with HIV can live almost as long as those without the virus. It highlights that starting and adhering to antiretroviral therapy (ART) as early as possible is crucial for extending lifespan.

Maintaining a healthy lifestyle and regular medical care also significantly improve life expectancy. The article also emphasizes that factors such as poverty, stigma, and delayed treatment negatively affect the health of people with HIV and suggests using community and medical resources to address these challenges.

If HIV is diagnosed early and treated promptly, individuals can expect a near-normal lifespan. Advances in antiretroviral therapy mean that people diagnosed with HIV and following medical advice can look forward to a longer and healthier life than ever before.

However, various factors—some controllable, others not—can influence these improvements and shorten life expectancy. Controllable risk factors include smoking and drug injection, while uncontrollable factors include race and gender.

Additionally, conditions such as diabetes, heart disease, and cancer are more common among people with HIV. Therefore, reducing the risk of these diseases is particularly important for extending lifespan and maintaining health.

This article explores current research on HIV and life expectancy, analyzes factors affecting life expectancy, and provides advice for those diagnosed with HIV to maintain a long and healthy life.

01. Changes in Life Expectancy for People with HIV

In 1996, when highly active antiretroviral therapy (HAART) was first introduced, the average life expectancy for a 20-year-old newly infected with HIV was 10 years. This new drug strategy, which combines multiple drug classes, significantly reduced mortality rates and greatly extended patient lifespans.

According to a 2013 study by the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), patients who began HIV treatment at age 20 can expect to live over 70 years.

This result was confirmed again in a 2023 review published in The Lancet HIV, which showed that the average life expectancy for newly diagnosed HIV patients in North America and Europe is between 70.8 and 74.6 years.

Considering that the average life expectancy for the general population in the U.S. is about 77 years, this means that individuals who start HIV treatment early can have a lifespan close to normal, and some may even live longer.

How to Extend Life Expectancy

According to current research, those who manage to live a long and healthy life with HIV often share some common traits, with the most important being regular medical care.

HIV requires lifelong treatment, and adherence to antiretroviral therapy is crucial. This means having regular blood tests to ensure the medication continues to work and to detect potential diseases or side effects early. Additionally, taking medication on time and ensuring an uninterrupted supply is key.

Studies show that continuous HIV specialty care can independently reduce the risk of AIDS-related death by 21%.

If you have recently been diagnosed with HIV, three things can help you live a healthy and long life:

1. Start Treatment Early

HIV treatment is most effective when started early, with a higher CD4 count.

CD4 count is a test used to measure the number of CD4 T cells in the blood. HIV specifically targets these white blood cells, gradually reducing their number over time. The CD4 count ranges from 0 to 1300 or more, reflecting the strength of your immune system.

Starting treatment when the CD4 count is above 200 is more likely to restore it to normal levels (500 or above). However, if treatment is delayed, the CD4 count may never fully recover, increasing the risk of various opportunistic infections (infections that typically occur in people with weakened immune systems).

Note: Delayed treatment shortens lifespan

Studies show that starting treatment when the CD4 count is below 200 results in an average lifespan reduction of about eight years compared to starting treatment when the CD4 count is above 200.

2. Quit Smoking

Studies show that smokers with HIV lose more years of life due to smoking than any other single factor. Smokers with HIV have twice the death risk of other smokers and an average lifespan reduction of 12 years.

Research published in Clinical Infectious Diseases indicates that a 35-year-old smoking person with HIV has an average life expectancy of about 63 years.

3. Avoid Injecting Drugs

People with HIV who use injected drugs face severe life loss due to HIV and non-HIV-related diseases. Injecting drug users are more likely to have serious opportunistic infections due to poorer adherence to treatment, and they also face higher risks of co-infection with other bloodborne diseases like hepatitis C, which further shortens their lifespan.

Studies show that HIV-positive individuals who inject drugs may have their lifespan shortened by up to 13.6 years compared to those who do not use injected drugs.

02. Factors Affecting Life Expectancy

Despite advances in diagnosis and treatment, some factors still influence the life expectancy of people with HIV. These factors include both controllable (such as adhering to daily medication) and uncontrollable (such as race, poverty, or genetics) elements.

Race

Race is closely linked to the lifespan of people with HIV, largely due to disparities in wealth among different racial or ethnic groups. For instance, the poverty rate among Black Americans is twice that of White Americans (17.1% vs. 8.6%).

Poverty and lack of medical resources are not the only manifestations of racial factors. Stigma, public health system failures, low health literacy, and language barriers are also common issues. These factors can lead to reduced life expectancy for people with HIV.

This is especially apparent in studies of men who have sex with men (MSM), who make up a significant portion of HIV infections in the U.S. A 2023 study published in JAMA Open Network found that due to the interplay of poverty, racial discrimination, stigma, and medical discrimination, Black MSM with HIV have an average life expectancy that is 6.8 years shorter than their White counterparts.

Socioeconomic Status

Poverty exacerbates every stage of HIV diagnosis, treatment, and prevention. Lack of access to quality healthcare, insurance, housing, and employment opportunities not only increases the risk of contracting HIV but also makes managing the disease more challenging.

Poverty is also associated with higher crime rates, drug abuse, incarceration, food insecurity, and social isolation, all of which impact the health of people with HIV. With nearly three-quarters of people with HIV in the U.S. living at or below the poverty line, this issue is particularly severe.

Low socioeconomic status limits access to treatment, the ability to pay for treatment, and maintaining an undetectable viral load (an indicator of sustained viral suppression). Without these conditions, life expectancy is almost certain to be reduced.

Research shows that women with HIV living below the poverty line are 5.7 times more likely to die prematurely compared to those living above the poverty line.

Gender

As with the general population, women with HIV tend to live longer than men. A study published in The Lancet HIV found that among 206,891 HIV-positive individuals in the UK, the average lifespan for women was 75.8 years, compared to 74.5 years for men.

Many of the same factors affecting life expectancy in the general population also influence those with HIV. Additionally, some biological factors may play a role, some of which are not fully understood.

For example, research shows that untreated women with HIV have up to 40% lower viral loads compared to men, related to stronger immune activation in women. After treatment, although adherence rates among women are typically lower, their risk of developing AIDS is also lower.

Genetics

Genetics may play a significant role in the life expectancy of people with HIV. Among HIV-positive individuals, there is a group known as long-term non-progressors (or “elite controllers”) who can control the virus without antiretroviral medication. It is estimated that about one in every 200 HIV-positive people may have this innate immune protection.

Elite controllers are believed to produce broadly neutralizing antibodies (bnAbs) that can combat various HIV genetic variants that ordinary immune systems cannot handle.

As a result, many elite controllers can enjoy a normal lifespan without treatment. A 2022 study in Spain showed that out of 313 elite controllers tracked over 30 years, only 2 died of AIDS-related diseases.

03. The Impact of Aging on HIV

As people age, the impact of HIV on health extends beyond HIV-related diseases. Even with successful HIV treatment, the risk of non-HIV-related diseases (such as cancer or heart disease) is significantly higher than in the general population.

This situation is so severe that today’s HIV-positive individuals are more likely to die prematurely from non-HIV-related diseases than from HIV-related causes.

Chronic Disease Risks

Even with treatment, HIV keeps the body in a state of low-level chronic inflammation. Over time, this inflammation can cause changes in important organs, leading them to "age" prematurely and increasing the risk of chronic diseases by 10 to 15 years earlier than in the general population. This risk is highest for those with unstable treatment and detectable viral loads.

These chronic diseases include:

• Cardiovascular Disease: HIV independently increases the risk of heart disease by 50% to 100%, including heart attacks, strokes, and heart failure.

• Cancer: The incidence of non-HIV-related cancers such as melanoma, lung cancer, and liver cancer is 4 to 8 times higher than in the general population, while the incidence of Hodgkin lymphoma and anal cancer is 41 times higher.

• Diabetes: HIV-positive individuals are twice as likely to develop diabetes as those without HIV.

How to Mitigate the Impact

Studies show that individuals who adhere strictly to treatment and regularly visit healthcare providers experience fewer complications from these chronic diseases. Additionally, managing lifestyle factors such as smoking and diet can also reduce the risks associated with aging.

In summary, regular treatment, early diagnosis, and maintaining a healthy lifestyle are crucial for managing HIV and extending life expectancy. While various uncontrollable factors affect life expectancy, advances in treatment and knowledge continue to improve outcomes and quality of life for people with HIV.

For More Information:

• Verywell Health
• The Lancet HIV
• Clinical Infectious Diseases
• JAMA Open Network