How Long Can You Live if You Get HIV?

It is natural to wonder how long you will live if you have HIV. While people will assure you that it's a treatable disease—and it most certainly is—what does that actually mean in terms of not only your lifespan but your quality of life?

While certain considerations play a role, by and large, the outlook is extremely good. With advances in antiretroviral therapy, people living with HIV today can expect to live longer and healthier than ever before if treatment is started early and taken as prescribed.

This article take a look at what the current research says about HIV and life expectancy. It also explores some of the factors that influence life expectancy, including those that can take back the gains afforded by modern antiretroviral therapy.

What the Current Research Says

At the time of the introduction of highly active antiretroviral therapy (HAART) in 1996, the average life expectancy of a 20-year-old newly infected with HIV was 10 years. With a new generation of drugs that are not only safer but more effective, those numbers have leaped significantly.

According to research from the longstanding North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), a 20-year-old started on HIV therapy today can expect to live into their early 70s.

With the life expectancy of the general U.S. population hovering around 77 years, this means that people treated early for HIV can enjoy near-normal life expectancies. Some can expect to do much better.

Factors That Reduce Life Expectancy

Despite these advances, there are factors that can increase or decrease the life expectancy of people with HIV. These range from things we can control (such as taking our pills every day) to things we can't (such as race or poverty).

These factors not only influence not only how a person responds to treatment but whether they are able to access treatment in the first place. Because of this, how long a person with HIV could live with HIV is often very different from an individual standpoint.

Moreover, HIV is only part of the long-term concern. Even among those on treatment, the risk of non-HIV-associated diseases, like cancer or heart disease, is far greater than in the general population and can occur anywhere from 10 to 15 years earlier.

So serious are these concerns that a person living with HIV today is far more likely to die prematurely of a non-HIV-related illness than an HIV-related one.

Losses in Life Years

There is not always a straight line between how certain risk factors increase or decrease the life expectancy of someone with HIV. This is because people tend to have overlapping risk factors.

Take, for example, Black men who have sex with men (MSM). The combination of racism, poverty, homophobia, and stigma—as well as the biological vulnerabilities to HIV—places Black MSM in the United States at a 50/50 chance of getting HIV in a lifetime.

There is other research illustrating how individual risk factors can reduce life expectancy in people living with HIV.

Delayed Treatment

HIV treatment is most effective when started during early infection when the CD4 count is high. A CD4 count measures the number of CD4 T-cells in a sample of blood. These are the white blood cells that HIV targets for infection, gradually killing off more and more over time. The CD4 count—which can range from 0 to 1,300 or more—is a strong indication of how strong or weak your immune system is.

For most people who are treated early, the CD4 count will return to normal levels (500 or above). For those who delay treatment, the CD4 count may never fully recover, leaving that person vulnerable to opportunistic infections.

Studies have shown that starting HIV therapy with a CD4 count under 200 reduces life expectancy by an average of eight years compared to someone starting at a CD4 count over 200.

Smoking

Studies have shown that smokers living with HIV today lose more life-years to smoking than any other independent cause. Moreover, the risk of death from smoking is twice as high among smokers with HIV, trimming an average of 12 years from their lifespan.

According to a 2013 study published in Clinical Infectious Diseases, a 35-year-old smoker living with HIV had a median life expectancy of roughly 63 years.

Race

Race and longevity in people with HIV are integrally linked. This is due in large part to high rates of poverty in communities of color. Without access to quality healthcare, insurance, housing, and employment, a person is not only more vulnerable to HIV but less likely to manage their disease effectively.

This is reflected in current mortality rates. According to 2012 research from the Centers for Disease Control and Prevention (CDC), the mortality rate among Blacks with HIV in the United States is no less than 13% higher than the rate among Whites with HIV.

Injecting Drug Use

Injecting drug users (IDUs) living with HIV suffer a loss in life years as a result of both HIV-and non-HIV-related illnesses.

Due to lower rates of treatment adherence, the rate of severe opportunistic infections is greater among people with HIV who inject drugs than those who don't. IDUs are also more likely to be co-infected like hepatitis C and other bloodborne diseases that further cut life expectancy.

All told, the mortality rate among IDUs with HIV is nearly twice as high as people with HIV who don't inject drugs.

Summary

Studies show that people living with HIV today can expect to live a near-normal life expectancy if treatment is started early and taken every day as prescribed. Even so, there are things that can undermine a person's ability to do so.

This includes factors likes poverty, stigma, racism, and homophobia that can stand in a person's way of accessing consistent care and treatment. Other factors like smoking and injecting drug use are directly linked to a loss of life years. Delayed treatment also reduces life expectancy because the immune system is less likely to recover, leaving the body vulnerable to infection.