Question

Dr. EWH / HHH,

I was recently reading some article and it got me curious what the life expectancy of people living with HIV currently is with modern medication. From what I understand current medication has evolved so much and is very potent. Is it more of a chronic condition now with modern drugs or not? Magic Johnson is living with it for a long while it seems and looks healthy every time I see him on TV.

Thank you.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

From your brief description, I would say the article you read was quite accurate.  In the US and other industrialized nations, or wherever financial, infrastructural, and medical technology limitations are not serious, HIV infected people can expect to live nearly normal lifespans.  It's a bit too soon to know if that prediction is truly accurate -- after all, we are only ~35 years into the known HIV/AIDS epidemic, and only 15 years into truly effective anti-HIV treatment.  Therefore, the current predictions will have to be proved by the actual experiences of people diagnosed in the past several years, treated aggressively, and followed for the next 30-50 years.

In addition, such long survival may depend on certain factors not yet known for certain, such as how important it is to start treatment early, whether certain combinations of anti-HIV drugs are more effective than others in long term survival, and so on.  Also, we are learning that long term HIV survivors probably have higher rates than HIV uninfected persons of coronary heart disease, stroke, and other health problems -- and perhaps higher rates of various cancerns as well.  It remains to be seen how much these problems will undercut the benefits of reduced mortality due to AIDS itself.

I would also emphasize the importance of my qualification above about infrastructure and technology.  Getting effective treatment and the necessary health care and infrastructures to places like sub-Saharan Africa and the Indian subcontinent are extraordinary challenges -- and the world cannot and should not consider the current successes sufficient until they are available to all who would benefit from them.  Finally, even in the most advanced, technological societies, there are many HIV infected persons who cannot adhere to treatment or otherwise cannot benefit from it.  Assuring survival and productive lives of HIV infected persons with psychological disabilities, addictions, and so on is another challenge for society and the medical professions.

On balance, the news at this time looks very, very good, especially in contrast to the incomparable tragedy and horrific history of the first 15 years of the epidemic.  Of course these benefits come with terrible costs, medically (e.g. drug side effects), financially, psychologically, and otherwise.  Nobody should lower their guard against HIV simply because survival has improved.  Any HIV infected person, whether recently diagnosed or already a long-term survivor, will tell you it's no picnic.

Best wishes--  HHH, MD

[bman124]

Thank you for such a detailed answer, Dr. HHH. When you say that "there are many HIV infected persons who cannot adhere to treatment or otherwise cannot benefit from it" - do you mean that some people simply don't react to the medication in an expected way?

[H. Hunter Handsfield, M.D.]

No, I mean that they cannot remember to take their pills, keep their appointments, etc -- sometimes because of addictions, mental health problems, and the like.  And in other cases just because that's how some people are.

[bman124]

Got it. Thank you, Dr. HHH.