How Long Can I Live If I Get HIV?

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

The answer is both simple and not-so-simple. By and large, the outlook is extremely positive. With advances in antiretroviral therapy, people with HIV can today expect to live longer and healthier than ever If treatment is started early and taken daily as directed.

In fact, a 20-year-old started on HIV therapy can expect to live into his or her early 70s, according to research from the longstanding North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

A 2011 research update from the Swiss Cohort Study further supported those finding, suggesting that people who start treatment early (at CD4 counts over 350) may be able to achieve a life expectancy equal to or even greater than that of the general population.

But that doesn't mean that there aren't challenges that can take back many of those gains. From an individual perspective, longevity is subject to numerous factors that can either increase or decrease life expectancy in a person with HIV. These factors range from things we can control (such as drug adherence) to things we can't (such as race or income status).

Moreover, HIV is really only part of the long-term concern. Even for those able to maintain an undetectable viral load, the risk of he non-HIV-associated diseases, like cancer and heart disease, is far greater than in the general population and can occur anywhere from 10 to 15 years earlier.

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

Factors that influence life expectancy are either static (fixed) or dynamic (able to change over time).

Static factors, like race or sexual orientation, influence life expectancy because they are ones people are often unable to escape. For example, high levels of poverty in African American communities combined with a lack of access to healthcare and high levels of HIV stigma take back many of the gains seen in white communities.

Dynamic factors, by comparison, have a strong cause-and-effect relation to survival times. For instance, treatment adherence is directly related disease progression. The less adherence is maintained, the greater the risk of drug resistance and treatment failure. With each failure, a person loses more and more treatment options.

When looking at both static and dynamic risk factors, we can begin to identify where an individual can gain or lose life-years without even knowing it. Among them:

• A person's CD4 count at the start of treatment remains one of the strongest indicators of life expectancy. Starting treatment when the CD4 count is below 200 can cut as much as 15 years from a person's life.
• Smokers with HIV lose more life-years to smoking than to HIV. In fact, the risk of death from smoking is twice as high among smokers with HIV and can trim as much as 12 years a person's lifespan irrespective of HIV.
• Race and longevity are integrally linked to HIV. According to research from the Bloomberg Public School of Health, African Americans with HIV live an average of 8.5 years less than their white counterparts.
• Injecting drug users suffer losses, both in terms of HIV-and non-HIV-related illnesses. The strongest contributing factors were poor adherence and hepatitis C co-infection. All told, life expectancy for injecting drug users is 20 years less than all other HIV groups.

In the end, it is important to remember that statistics are not a prognosis. They cannot predict what will happen during the course of an infection. They can only suggest what you steps you can take to minimize the risk of illness based on the factors you, as an individual, can readily change.