Q&A: Today's Life Expectancy With HIV

Q: Today, with all the treatments available, about how long is the life expectancy of someone with HIV (if that person is living a healthy lifestyle, taking their meds, having protected sex and seeing their doctor regularly, in general? If it develops into AIDS, how does the life expectancy of that same person change?

A: The first medical reports of HIV-infection in the US appeared around 1981.  Human Immunodeficiency Virus was identified as the culprit in 1983.  Azidothymidine (AZT/zidovudine/retrovir) was approved as the first drug for treating HIV infection in 1987.  Other drugs were approaved afterwards: ddi (didanosine/Videx), ddc (zalcitabine; no longer in use), 3TC (lamivudine/Epivir) and d4t (stavudine/Zerit).

These drugs belong to the same class are have relatively weak effects
against suppressing HIV when used alone.  The big break in treating HIV
infection came around 1995.  In 1995-6, new classes of drugs became
available that were more potent than the earlier drugs.  In addition,
combining these more potent drugs with the older drugs allowed
clinicians to totally suppress the replication of the HIV virus.  These
advances in pharmacology and treatment dramatically reduced the
mortality from HIV disease.  But the benefits from reduced mortality
were not seen equally across all groups.  Studies have confirmed that
African-Americans (and other minorities) were least likely to be
prescribed the potent, combination regimens that were life-saving.1
More troubling were studies that revealed patterns of racial bias, where
providers would treat white patients earlier and more frequently with
potent drugs like the protease inhibitors than they would black
patients2.  While this problem hasn’t been eliminated, better training
of minority providers and closer monitoring of care delivered to
disadvantaged communities may be paying off.

The good news is that things have only gotten better.  We have more
drugs.  We have new classes of drugs that work in very different ways
and are extremely potent in suppressing the virus.  Some of them are
active against drug-resistant viruses and some of them have few
side-effects.  The dosing regimens have been simplified to the point
that combination therapies can be given in one pill once a day. So what
effects do these imporved treatments have on life expectancy?

In one study, individuals with HIV-infection and those without infection
were followed and their life expectancy predicted.  The average age of
diagnosis for the HIV-infected persons was 33 years old.  Predicted life
expectancy for the individuals without HIV infection (but with similar
characteristics as the HIV patients) was an additional 34 years (beyond
33 years) whereas in individuals with HIV (assuming they receive
recommended treatment) was 12 years less, or an additional 24 years
(beyond 33 years)3.  In another study, life expectancy increased from an
average of 10.5 years after HIV diagnosis in 1996 to 22.5 years after
diagnosis in 20054.

In a study done in Denmark, a person diagnosed with HIV in 2007 at age 25 was expected to live an additional 39 years.And now,  the bad news: In most studies, African-Americans continue to have reduced life expectancy with HIV-infection compared to whites. Factors that contribute to life expectancy are late
diagnosis of infection and interruptions in treatment.
African-Americans are more likely to be diagnosed late, which means that
the virus has caused more damage to the immune system (and other
systems) and that the response to therapy is less than optimal.    There
are a large number of studies that showed individuals who start therapy
after being diagnosed with AIDS do not survive as long as those who are
started on medicines earlier, but a lot of this depends on how well
these patients stay on therapy and the other medical conditions they
have. However, the powerful drugs we have now are effective even in
people with advanced disease.   People who do not stay on their regimen
as prescribed, usually because of poor adherence, may progress more
rapidly and also are more likely to have resistant virus.

Obesity is another one.  These are called “modifiable risks” because the individual can reduce or eliminate them by changing their behavior.

Without trying to play God, I can make some recommendations that you have control over that can improve life expectancy.

1. Get tested!  Know your HIV status
2. Start therapy early according to the most current guidelines for HIV management (www.aidsinfo.nih.gov/). Discuss this topic with your medical provider
3. If started on HIV medicines, follow the regimen as prescribed by your provider.
4. Manage your other medical conditions
5. Stop smoking! Consult with a health provider if you need help. Smoking is a powerful addiction but there are ways to improve your success.
6. Eat a heart healthy diet and engage in regular physical activity. Lose weight if necessary. Consult with a nutritionist and other medical providers.
7. Move to Denmark (Copenhagen is a lovely city but cold in winter).

Today, an HIV diagnosis is very far from the death sentence it was in the ‘80’s. the more we learn, the better we do in extending life with a high quality. I have seen quite a few patients whose have been infected well over 20 years, whose HIV is controlled and who are otherwise healthy.  If you are HIV-infected, you can be one of them.

References:

1. Anderson KH, Mitchell JM., Arch Intern Med. 2000 Nov 13;160(20):3114-20. Differential access in the receipt of antiretroviral drugs for the treatment of AIDS and its implications for survival.

2. King WD, Wong MD, Shapiro MF, Landon BE, Cunningham WE.J Gen Intern Med. 2004 Nov;19(11):1146-53. Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors?

3. Losina E,  et al. Clin Infect Dis. 2009 Nov 15;49(10):1570-8. Racial and sex disparities in life expectancy losses among HIV-infected persons in the United states: impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy.

4. Harrison KM, Song R, Zhang X. J Acquir Immune Defic Syndr. 2010 Jan 1;53(1):124-30. Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States.

5. Lohse N, Hansen AB, Gerstoft J, Obel N. J Antimicrob Chemother. 2007 Sep;60(3):461-3. Epub 2007 Jul 2. Improved survival in HIV-infected persons: consequences and perspectives.

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