From the Guidelines
People with HIV who take effective antiretroviral therapy (ART) can now expect to live nearly as long as those without HIV, often into their 70s or beyond. This is due to the significant advances in HIV prevention and management with antiretroviral drugs, as highlighted in the 2020 recommendations of the International Antiviral Society-USA panel 1. The success of ART has led to a substantial increase in survival, allowing persons with HIV to live a near-normal lifespan.
To achieve a normal life expectancy, it's crucial to:
- Start ART as soon as possible after diagnosis, as recommended by the International Antiviral Society-USA panel 1
- Take medications consistently as prescribed, such as modern ART regimens consisting of a combination of 3 or more antiretroviral drugs taken daily
- Attend regular medical check-ups to monitor the effectiveness of treatment and address any potential issues
- Maintain a healthy lifestyle, including a balanced diet, regular exercise, and avoidance of smoking
The use of antiretroviral drugs for the treatment and prevention of HIV infection has emerged as a highly effective strategy, with novel long-acting injectable ART regimens administered once every 4 weeks, and potentially every 8 weeks, demonstrating effectiveness for treatment 1. Additionally, early and consistent treatment is key to maximizing life expectancy and quality of life for people living with HIV, as it allows the immune system to recover and prevents progression to AIDS. With an undetectable viral load, HIV-positive individuals can also prevent transmission to others.
From the Research
Life Expectancy of Individuals with HIV on Antiretroviral Therapy (ART)
- The life expectancy of individuals with HIV on ART has increased significantly over the years, with studies showing that HIV-related deaths have dramatically decreased and HIV infection has become a chronic disease 2.
- A study published in 2017 found that the life expectancy of patients starting combination ART between 1996 and 2013 increased by about 9 years in women and 10 years in men 3.
- Another study published in 2016 found that life expectancy in HIV-positive people on ART ranged from 60.3% to 89.1% of the life expectancy in the HIV-negative or general population, depending on the region and time period 4.
- Despite these improvements, the life expectancy of treated patients is still shorter compared to that of uninfected individuals, with older HIV patients tend to have a worse immunological response to antiviral therapy 2.
- The willingness to risk death for a cure varied widely among people living with HIV, with a median of 10% and a 75th percentile of 50%, and was associated with expected long-term side effects of ART, greater financial resources, and being employed 5.
Factors Affecting Life Expectancy
- The use of less toxic antiretroviral drugs, improved adherence, prophylactic measures, and management of comorbidity have contributed to the improvement in life expectancy of HIV-positive individuals on ART 3.
- The life expectancy of HIV-positive individuals on ART is affected by factors such as age, sex, AIDS, risk group, CD4 cell count, and HIV-1 RNA at start of ART 3.
- Regional and gender differences also exist, with life expectancy in HIV-positive people on ART being higher in women than in men in most countries, except for Canada where the opposite was found 4.
Current State of ART
- Highly effective ART has transformed HIV care in the past 3 decades, with single-tablet daily regimens achieving sustained HIV-1 suppression and halting disease progression to AIDS 6.
- New antiretroviral agents and those undergoing phase 2/3 clinical trials hold great promise to expand treatment options and fill gaps in HIV care 6.