Can people with HIV live as long as people who are HIV negative?

Thanks to antiretroviral therapy (ART), also known as highly active antiretrovirals (HAART), the human immunodeficiency virus (HIV), is no longer the same death sentence it was years ago. People living with HIV can live longer and fuller lives, near or even as long as someone without HIV.

HIV infections attack the immune system, making someone who is HIV-positive susceptible to a variety of infections and diseases. HIV can be transmitted through contact with semen, blood, pre-seminal fluid, rectal fluids, vaginal fluids, or breast milk of someone who has HIV (AIDS info-a, 2019).

Without ART, HIV progresses to acquired immunodeficiency syndrome (AIDS). According to AIDS.org, untreated HIV can lead to AIDS within 8-11 years (AIDS.org, n.d.). People who develop AIDS without taking any kind of HIV treatment typically live about three years, post-AIDS diagnosis (HIV.gov-a, n.d.). That life expectancy shortens to one year once they develop a dangerous opportunistic illness like candidiasis, herpes simplex virus, or tuberculosis (CDC-a, 2019). Taking and adhering to ART can help people who are HIV-positive live longer and healthy lives.

HIV has three stages of infection— acute HIV infection, chronic HIV infection (sometimes known as clinical latency), and AIDS. While during the acute HIV infection phase, you might feel like you have the flu, the clinical latency phase is asymptomatic. That’s why it’s easy to mistake your initial flu-like symptoms during the acute infection phase for something that comes to pass when the underlying cause actually requires more treatment. If you do start taking ART during this phase, it is still possible to start maintaining an undetectable viral load and have no risk of transmitting HIV to a sexual partner (AIDS Info-a, 2019).

“Quality of life” (QOL) is a health term that refers to an overall sense of wellbeing an individual experiences through healthiness and happiness in the remainder of their years on Earth. Thanks to advances in ART, HIV/AIDS is a significantly more manageable chronic disease than the scary death sentence it was just years ago. Additionally, one study found important, non-medical factors that played a role in improved QOL of HIV patients included social support and mental help (Basavaraj, 2010). With treatment, adherence to the medication regimen, and asking for help, someone who is HIV-positive can still live a happy and fairly long life.

The Centers for Disease Control and Prevention (CDC) estimates that the average person lives to 79 years old. With HIV treatment, someone diagnosed with HIV as a 20-year-old can live up to 71 years on average. However, without treatment, the prognosis is grim: Someone diagnosed with HIV as a 20-year-old without medication lives to 32 years of age, on average (CDC, 2014).

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While following your healthcare provider’s directions regarding your HIV treatment affects your health, other determinants can play a factor in your life expectancy.

Age

Before the development of ART, people with HIV/AIDS were not expected to live long and usually succumbed to their condition within one or two years. In a 2019 study, the CDC found that out of the 1.1 million people in the U.S. who are HIV positive, 36% (400,000) were 55 years old or older (CDC-b, 2019).

However, HIV affects the immune system. Even without HIV, the immune system naturally begins to decline with age. People who are HIV-positive tend to be more prone to multiple chronic conditions and environmental stressors. These conditions include cardiovascular disease, lung disease, certain cancers, and liver disease (HIV.gov-b, 2020).

HIV also affects the nervous system. HIV patients show cognitive impairment over time, giving rise to a group of conditions called HIV-associated neurocognitive disorders (HANDs). Some examples include asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV associated dementia (HAD) (Clifford, 2013). Researchers believe more than 50% of people who are HIV-positive have developed some form of HAND (HIV.gov-b, 2020).

Social determinants of health

People and their health conditions do not exist in a vacuum. The structural and societal conditions that influence a wide range of health risks and outcomes are called social determinants of health (CDC, 2018). Social determinants of health include access to care, availability of medications, affordability of treatment, housing, and stigma, along with gender, sexual orientation, and more. Studies find that the United States experiences disproportionate and substantial health disparities when compared to other industrialized nations (Dean, 2010).

HIV stigma is defined as the societal pressure of negative attitudes and beliefs about people living with HIV. People living with HIV can internalize negative stigma in a way that prevents them from seeking out the care they need. HIV stigma can also prevent people from even getting tested, causing them to unknowingly spread it to other people, and delay seeking help (CDC-c, 2019).

Smoking, drug, and alcohol use

Smoking, drug use, and alcohol can affect the health of a person with HIV in a multitude of ways. 

First, these substances can weaken the immune system. HIV attacks the immune system, so engaging in drugs and alcohol exacerbates that damage. This can make it even harder for your body to fight off infection and disease.

Second, drugs and alcohol can affect the liver. People who have HIV are prone to developing two types of hepatitis—hepatitis B (HIV/HBV) and hepatitis C (HIV/HCV). Having HIV and a form of hepatitis at the same time is called coinfection.

Third, drugs and alcohol can interact with medicine, especially HIV medications. A drug interaction can potentially damage your body, impact the treatment’s effect, or cause adverse side effects. Cases have reported overdoses between HIV medications and recreational drugs such as ecstasy (MDMA), crystal meth, and ketamine (Mayer 2006; AIDS info-b, 2019).

Pre-existing conditions

Because HIV affects the immune system, it can affect conditions you had and the medications you took prior to exposure. People with high blood sugar or type 2 diabetes should tell their healthcare provider about their pre-existing condition because HIV medications can affect blood sugar levels (AIDS info-c, 2019). If you have hepatitis B or hepatitis C, you could be at risk for hepatotoxicity by taking certain HIV medications. Hepatotoxicity is a potentially life-threatening side effect that refers to liver damage caused by a medicine, chemical, or dietary supplement, including HIV medications. (AIDS info-c, 2019). HIV medications can also interact with medicines that lower cholesterol levels, which are often called statins (AIDS info-e, 2019). Make sure your healthcare provider has a full picture of your health before starting any new medications. 

HIV-related illnesses

When your immune system is compromised, you are more at risk of contracting an opportunistic infection. Opportunistic infections (OIs) occur more often or more severely in people with weakened immune systems compared to people with healthy immune systems. Some OIs associated with HIV include pneumonia, tuberculosis (TB), candidiasis, and herpes simplex virus (AIDS Info, 2020).

Taking HIV medications can help lower or prevent the chance of people living with HIV contract an OI. These medicines help keep the virus from damaging the immune system. Without them, someone who is HIV positive has a higher risk of dying from diseases and infections that are otherwise easily treatable under a low viral load. Additionally, uncontrolled HIV can progress to AIDS. Some OIs, like certain forms of TB, are AIDS-defining conditions, meaning the condition is life-threatening to someone with HIV (AIDS Info-a, n.d.).

Viral load

As of 2020, there is no known cure for HIV. However, thanks to antiretroviral therapy (ART), HIV can be managed by keeping the viral load suppressed to an undetectable level. Viral load refers to the number of HIV copies per milliliter of blood. By keeping this number low, the immune system can still fight off infection and disease, despite the presence of HIV. Additionally, a maintained undetectable viral load presents effectively no risk of transmission (AIDS info-c, n.d.; Bhatti, 2016). 

CD4 cell count

HIV specifically targets CD4 T lymphocytes. The CD4 T lymphocyte is a white blood cell nicknamed the “helper T cell” because it helps other immune cells, such as macrophages, B lymphocytes (B cells), and CD8 T lymphocytes (CD8 cells), coordinate attacks against invaders. In HIV treatment, CD4 count is closely monitored as the most important laboratory indicator of immune function and the strongest predictor of HIV progression because CD4 will respond to ART (AIDS info-b, n.d.).

CD4 cell count indicates where someone is in HIV progression. In the early stages of HIV, your CD4 immune cell count will begin to drop. According to one study, starting ART early at high CD4 count was a difference in life expectancy of around seven years when compared to people who started ART later at a lower CD4 count at the same age (Marcus, 2020).

Starting ART with a higher CD4 count is also associated with developing fewer comorbidities over the rest of a person’s life. Comorbidity refers to the presence of two or more conditions in a patient at the same time. Comorbidities can interact with each other, exacerbate symptoms, and necessitate a change in treatment (Valderas, 2009). HIV comorbidities include cancer, diabetes, and chronic disease of any major organ. 

Researchers even gathered the results from three studies that looked at the different outcomes in life expectancy based on the starting point of ART. From those studies, researchers concluded to do away with waiting until a certain threshold in CD4 count and, instead, treat all HIV-infected persons with ART as soon as possible. They also found the health of patients who started ART early was almost 44-57% better than those who started it later at reduced CD4 cell counts (Eholie, 2010).

A typical ART regimen includes at least three medications. The prescribed medications do things like blocking HIV from entering CD4 cells or disable virus proteins that allow them to replicate. People need to adhere to their doctors’ orders regarding ART, not only because it improves the efficacy of the medication, but also prevents the chance of drug resistance. Drug resistance refers to the ability of pathogens like bacteria and viruses to mutate into forms that aren’t affected by medications.The goals of ART include the following: 

• Manage viral load

• Increase CD4 cell count

• Slow disease progression

• Reduce the risk of transmission 

Someone who is HIV-positive could have conditions that conflict with ART, like kidney problems, pregnancy, or being a pediatric patient. Fortunately, there are multiple lines of treatment options to work around these conditions. Figuring out an ART regimen could take some time, along with trial and error, which is another reason why it’s important to get started on ART as soon as possible (Bhatti, 2016).

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

July 20, 2020

Written by

Gerrie Lim, MPH

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.