How an HIV Diagnosis Can (Sometimes) Lead to a Longer Life
You are probably thinking that it’s ludicrous to assert that a potentially deadly virus such as HIV can actually improve the quality of your health and lead to a longer life. But believe it or not, Dr. Roy "Trip" Gulick, Chief of the Division of Infectious Diseases in the Department of Medicine at the Weill Cornell Medical College and New York-Presbyterian Hospital/Weill Cornell Medical Center, stated just that at a Plenary Session at the 2015 International AIDS Society Conference held in Vancouver, Canada on July 21.
Researchers from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study reported that a person diagnosed today with HIV at 20 years old or older and on antiretroviral therapy (ART) can expect to live longer than the average life expectancy. The report said that someone aged 20 or older and HIV-positive on ART in the U.S. or Canada is now expected to live into their early 70’s, a life expectancy approaching that of the general population. However, if that 20-year-old is either a man who has sex with men (MSM) or someone who starts HIV treatment with a CD4 count at or above 350, they can expect to live an additional 69 years, or to approximately 89 years old, 10-12 years longer than the general non-HIV-infected population.
Dr. Gary Blick, Chief Medical Officer of World Health Clinicians and co-founder of HIV Equal, was in attendance when these findings were presented in Vancouver.
“When I heard Dr. Gulick present these findings in Vancouver, I was absolutely astounded. I asked myself ‘Have we gotten this good in the care and treatment of HIV-positive individuals?’ This study clearly shows the increasing longevity for HIV-positive individuals living in the U.S. and Canada. The dramatic increase in life expectancy at age 20 from 36.1 years, where it was in the period from 2000 to 2002, to 51.4 years in 2006–2007 is clear evidence of the success of our newer and improved HIV drugs.
The NA-ACCORD study, which represents an increase in longevity for HIV-positive individuals living in the U.S. and Canada, demonstrates a dramatic increase in life expectancy at age 20 from 36.1 years, where it was in the period from 2000 to 2002, to 51.4 years in 2006–2007. Dr. Blick says that this is clear evidence of the success of our newer and improved HIV drugs.
“One of the main reasons for the increase in life expectancy above that of the general population has everything to do with knowing your HIV status,” Dr. Blick (pictured) said. “If you are diagnosed with HIV and get in and stay in care, you will get better monitoring and treatment than someone in the general population who might otherwise not seek medical attention. The only sobering fact is that large differences in life expectancy still continue to persist in certain patient sub-groups, such as between MSM and intravenous drug users or other HIV risk groups, as well as between Caucasians and all other races. We need to better understand the specific reasons for these life expectancy differences and improvements”.
NA-ACCORD is part of the International epidemiologic Databases to Evaluate AIDS (IeDEA) which began in 2006. It is a collaboration between 25 large HIV treatment centers in the U.S. and Canada that are thought to be representative of HIV care in these countries. The main purpose of NA-ACCORD is to examine life expectancy changes between 2000 and 2007 in Canadian and American HIV-positive individuals taking ART, as well as to compare life expectancy by age, sex, HIV risk group, race, and CD4 counts at the time of starting ART. This data is essential in understanding what priorities to target to improve health services, especially since HIV and aging has become such an important topic.
A person living with HIV is at a substantially higher risk of developing a variety of health complications such as heart attack, stroke, and a variety of cancers including lung cancer, colon cancer and prostate cancer. Given this knowledge, however, a younger person can take proactive measures to prevent illnesses that they would ordinarily not think about until decades later. A person’s primary healthcare provider also regularly monitors an HIV-positive person for early signs of any complications or illnesses, which often allows for a person to take corrective measures before an illness can develop into a more serious concern.
But just because a person with HIV can live a longer life, doesn’t mean that it is the reality for many people living with the disease. In the United States, only 30 percent of people living with HIV are accessing and staying in care and managing their virus correctly. In fact, 50% of those diagnosed with HIV have fallen out of care and therefore are not accessing life-saving medical care and prevention. For a person newly diagnosed, this can often mean taking one pill a day and visiting their doctor for routine blood work every four months once undetectable viral levels are reached. This, however, is easier said than done, as many people who are newly diagnosed face financial, societal and psychological barriers that keep them from accessing quality care.
For example, HIV affects young gay and bisexual men and transgender women of color at an alarmingly disproportionate rate. Geography also plays a key role, as southern states in the U.S. account for more than 50 percent of all new infections, even though these states only hold one-third of the population. A young gay or bisexual man or trans woman can face adversity from their community, judgment and shame from their family, friends and churches, and even improper care by a healthcare worker who isn’t educated on HIV related issues.
These findings show the optimum possibilities of life with HIV, but are in stark contrast with many people’s reality when it comes to managing the virus. But, as the study shows, the physiological care for HIV now has the potential to provide an HIV-positive person with an even longer than expected life, but societal and psychological improvements are still greatly needed so that the majority of people with HIV can turn that possibility into a reality.