How Long Does It Take for HIV to Progress to AIDS?

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Question: How long does it take for HIV to progress to AIDS?

Answer: In all but a few rare cases, if left untreated, HIV will progress to a stage of infection we call AIDS. This is when the immune defenses have been compromised, and the body is less able to defend itself against potentially life-threatening infections.

Generally speaking, the time it takes to go from HIV infection to AIDS is around 5-10 years if no medical intervention is made. Differences in time can be due to any number of factors, including:

  • The genetic strain of HIV a person has been infected with (some of which may be more or less virulent than others)
  • The general health of the individual
  • The place where the person lives (including healthcare access and incidence of other diseases or infections)
  • A person's genetics or family history
  • Smoking and other personal lifestyle choices

This is, of course, if the person receives no treatment. The picture changes entirely if he or she does.

Since 1996, the introduction of antiretroviral drugs has dramatically altered the natural progression of HIV infection. While HIV still cannot be cured, people newly diagnosed with HIV who get treated and stay in care can be expected to have near-normal to normal life expectancies. As with other chronic diseases, early detection is key to identifying and treating the infection as soon as possible.

Understanding the Stages of HIV Infection

The stages of infection from person to person vary slightly, both in severity and the speed of progression. These stages map the depletion of immune cells (called CD4 T-cells) as the body's defenses further and further degrade. With each progression, the risk of opportunistic infections (OIs) increases until the immune system is said to be fully compromised. It is at this stage that the risk of illness and death is particularly high.

The stages of infection can be roughly classified as follows:

  1. Acute infection - the stage where the body fights the new infection, often causing a symptomatic, inflammatory response called acute retrovirus syndrome, or ARS.
  2. Chronic infection - after initial infection has been controlled by the immune system, the virus goes into hiding in cellular reservoirs, unnoticed by immune defenses. This chronic (or latent) stage of infection can last for years and even decades in some individuals until such time as the hidden viruses are reactivated (most often when the immune system is fully compromised and later-stage OI develops).
  3. AIDS - the stage technically classified as having either an AIDS-defining condition or a CD4 count of under 200 cells/mL.

An AIDS diagnosis no longer means that a person will definitely get sick or die. Even if a person has a CD4 count below 100 cells/mL, the initiation of antiretroviral treatment can reconstitute immune function, occasionally to levels considered near-normal to normal.

Still, a complete cure remains elusive: a person cannot yet improve to a state where he or she no longer has AIDS. Although two patients have been reported to be in long-term remission from HIV one year after ceasing ART, both were the recipients of bone marrow transplants intended to treat cancer, not HIV. Long-term remission outside of these patients has not been reported.

In addition, the chance of a full immune recovery decreases the longer a person waits. It is, therefore, important that treatment is provided at the time of diagnosis, irrespective of the CD4 count, and that the person remain adherent to treatment for the span of his or her life.

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