A recently published study contains some very good news for people living with HIV. It suggests that the life expectancy for a person newly diagnosed with HIV, with no symptoms, has jumped from seven years to 24.
This changes everything. Most experts agree that HIV infection is no longer a death sentence. Instead, it is a chronic, long-term disease. Before 1995, a newly infected person faced the near-certainty of dying with AIDS. Today a newly infected person can look forward to 24 years -and potentially much more! - of living with HIV.
We spoke with three HIV experts about this change, and about what it means to people living with HIV today.
Let’s start with a little history.
1995: The Year Everything Changed
Prior to 1995, there were no effective treatments for HIV. But in1995 the first protease inhibitors were introduced, and doctors discovered that a combination of three or more HIV medications could stop HIV in its tracks. The new combination treatments were called HAART - Highly Active Anti-Retroviral Therapy - and the results were dramatic! People who were days away from death came back to life.
“I’ve been involved with HIV since early medical school,” says Rick Stryker, MD, a Clinician and Regional Director for Abbott Laboratories’ Global Antiviral Team. “When I first started doing this, I would have dozens of patients in the hospital, many with a poor prognosis. We didn’t know enough about HIV to successfully treat them. I could tell you many sad stories about patients - including personal friends and even a family member - who passed away before effective treatments were found.”
“Everything changed overnight in 1995 with the first protease inhibitor,” Dr. Stryker continues. “In the beginning of 1995, most of my patients were in the hospital. That all went away within a year. And things have continued to improve with the availability of newer and better treatments.”
The Diabetes Comparison
Gary Thal, MD, Director of Medical Affairs for Bristol-Myers Squibbs, compares HIV to another chronic long-term disease: diabetes. “The typical person with HIV needs to think about how to manage a chronic disease for the rest of their life, as they would with diabetes,” Dr. Thal says. “For most patients in the developed world, HIV is no longer a death sentence. But it’s certainly not a trivial disease or anything to be cavalier about. It’s not easy to live with HIV, just as it’s not easy to be a diabetic. But it is doable. Patients need to make that commitment to manage it.”
Dan Seekins, MD, Director of Efavirenz and Nucleoside Agents for BMS in the US and globally, agrees with the diabetes comparison. “Yes, I think it’s fair to compare HIV to diabetes,” Dr. Seekins says. “You see the same thing with diabetes as you do with HIV: people who eat right and take their medications do well, and those who don’t, don’t. So I think that’s a pretty fair analogy.”
Getting your full 24 - and more!
What does it take to make sure you get your full 24 years, and even more?
“Seek treatment early, be fully adherent and have a good partnership with your physician,” says Dr. Stryker. “The adherence part is absolutely critical. Studies show that patients who take their medication 95 - 100% of the time have the best prognosis. It drops off fairly sharply after that. Even after years and years of undetectable viral load, if something changes the virus can and will escape rather quickly.”
Dr. Seekins also stresses the importance of adherence. “Medicines don’t work if patients don’t take them,” Dr. Seekins says. “People feel better, they’re working again and dating again, and they forget to take their pills. That’s the biggest mistake you can make.”
“Pick a treatment that fits your lifestyle,” Dr. Seekins continues. “Make sure it’s something you can commit to. That involves understanding your treatment options and what you’re going to have to do as a patient to really get good results.”
And don’t overlook the obvious: “The biggest thing anyone can do to live longer is stop smoking,” Dr. Seekins notes. “Moderate exercise also clearly shows a benefit, not only directly but also by lowering your blood pressure and cholesterol.”
Hope for the Future
The doctors we talked to all expect that the life expectancy for someone newly diagnosed with HIV can be even longer than 24 years in the future.
“I’m not sure there’s any reason why there has to be a more limited life expectancy for people with HIV than without,” say Dr. Thal. “We’re not there yet, but over time there’s no reason someone with HIV shouldn’t have a normal lifespan. It will require getting people into the system earlier, patient commitment, continued research, and continuing to identify optimal ways to treat. Of course, as long as there are patients who are not compliant or don’t have access to health care, their life expectancy is going to be limited and that will contribute to the overall demographics of the epidemic.”
“Chances are excellent that lifespan will continue to improve,” echoes Dr. Stryker. “Most of the increase is due to improved management and much better treatments that are capable of fully suppressing HIV and essentially putting someone into a remission state.”
“People should not be lured into thinking that HIV is not a big deal - that they can do whatever they want and we have the resources to pick up the pieces if they get infected,” Dr. Stryker adds. “Prevention is much better than treatment. That said, a patient who is really willing and able to fully participate in treatment can have a really excellent response. There’s every reason to believe many people will live a normal lifespan well beyond 24 years.”
Responsibility to the Next Generation
All of the doctors we spoke to agreed that the reported increase in life expectancy for people with HIV is a great thing - but they also cautioned against complacency.
“Not to diminish the good news,” said Dr. Thal. “But it’s important for the general population not to become complacent about this disease, not to diminish their efforts at risk-prevention. We can’t allow this to let us turn our back on HIV. We can’t say, ‘OK, we’ve solved this one, now let’s move on to the next disease of the week.’”
“If people with HIV stop reminding the rest of us, it could become a forgotten disease,” Dr. Thal continues. “If we become complacent about it, what happens to the millions of people outside the developed world who are still 20 years behind us?”
“Unless we keep working on it, the 24 years won’t turn into 34 , then 44, then 54. We need the reminder that, yes, you’re living longer. But you’re not living disease-free.”
Dr. Stryker says, “Early in the HAART era there was a lot of optimism that a combination of drugs would be able to able to eradicate the virus fully. But no one has completely eradicated HIV with the currently available drugs. There are sanctuary sites in the body where the virus can hide out. We’ll need new therapies that can eradicate the small amount of virus that remains in patients who are fully suppressed.”
“Is that around the corner? No. But it’s a goal that’s out there for the future.”
“A cure is an elusive goal and one that will take a long time to achieve,” agrees Dr. Thal. “The virus mutates itself and can escape the current medications. I hope that a cure is possible. I think it’s possible. In the short term? I doubt it. But you never know before you find something that you’re going to find it. We’re looking for both a cure and a preventative. We didn’t eradicate polio by curing it, we eradicated it by preventing it.”
Copyright 2013, Positive Health Publications, Inc.
This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!