HIV Life Expectancy: Living a Long Life With Treatment

I still remember the faces of many patients on the day they got their result. Some went quiet, some cried, and many asked the same question: "How many years do I have left?" The answer today is very different from 30 years ago. HIV is no longer a death sentence. It is a manageable long-term condition, much like diabetes or high blood pressure, which need ongoing medicine and follow-up.

What do the latest figures show?

A large study by the ART-CC collaboration, published in Lancet HIV in 2023, pooled data on more than 200,000 adults on long-term antiretroviral treatment in Europe and North America. It found that:

• People who started treatment after 2015 have an average life expectancy of about 77 years for men and 79 years for women, higher than in earlier eras.
• The most important factor was the CD4 count at the start of follow-up. People with a CD4 count above 500 had a life expectancy very close to the general population, while those with a CD4 count below 50 had about 15 fewer years.
• A small gap remains compared with people without HIV, partly due to smoking, drug use and other conditions.

These figures come from high-income countries, but Thailand has a free antiretroviral programme available nationwide for Thai nationals and uses the same regimens recommended worldwide. The key is the same everywhere: "test early, start early, keep taking it."

Compared with the same group's earlier report (Lancet HIV 2017), which studied about 88,500 people who started treatment between 1996 and 2010, life expectancy at age 20 rose by about 9–10 years over that period. The 2023 data also showed that women with HIV aged 40 had a life expectancy about 7 years shorter than women in the general population, and men about 4 years shorter.

Followed from high CD4

Above 500

• Life expectancy close to the general population
• Immunity still good
• Low risk of opportunistic infections

Followed from very low CD4

Below 50

• Roughly 15 years shorter life expectancy
• Often first seen once an opportunistic infection has occurred

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ART-CC (Lancet HIV 2023): for those starting treatment after 2015, life expectancy is about 77 years for men and 79 for women.

Why antiretroviral treatment changes lives so much

Today's antiretroviral medicines suppress the virus quickly and powerfully. The main regimen in Thailand is TLD, one tablet a day, with few side effects. Once the virus is suppressed to undetectable, the immune system gradually recovers, the risk of opportunistic infections falls sharply, and there is no sexual transmission, according to U=U. People who keep taking their medicine can work, study, fall in love, marry and have children.

Living long and well with HIV: what to do

1. Take your medicine every day at the same time. Use a phone alarm or a weekly pill box. Do not stop on your own, even if you feel well.
2. Keep your viral load appointments. If the virus becomes detectable again, your doctor can adjust the plan quickly.
3. Stop smoking. In people with HIV whose virus is controlled, smoking may shorten life more than HIV itself.
4. Look after your heart and blood vessels. Have your blood pressure, blood sugar and cholesterol checked regularly. People with HIV have a higher risk of heart disease than the general population. The REPRIEVE study (NEJM 2023) found that a statin cholesterol-lowering medicine reduced heart disease events in people with HIV. Your doctor will assess whether you should take one.
5. Get vaccinated for your age, such as influenza, pneumococcal, hepatitis B and HPV vaccines.
6. Cancer screening, such as for cervical cancer, and anal cancer in higher-risk groups.
7. Look after your mind. Stress, stigma and depression are common in people with HIV. Having someone to listen matters as much as medicine.
8. Avoid heavy drinking and drugs, which make it easy to forget doses and damage the liver.

Long, good life

Medicine and monitoring

• Take pills daily at the same time
• Viral load tests as scheduled

Heart and vessels

• Stop smoking
• Check blood pressure, sugar, lipids
• Statins as assessed by your doctor

Disease prevention

• Age-appropriate vaccines
• Cervical and anal cancer screening

Mind and habits

• Have someone to listen; treat depression
• Avoid alcohol and drugs

Things to avoid

• Stopping your medicine because the virus is undetectable, or switching to herbal remedies instead of antiretrovirals. No herbal remedy or supplement can treat HIV.
• Buying extra medicines without telling your doctor, because some, such as antacids and minerals, reduce the absorption of antiretrovirals.
• Isolating yourself so no one can help. If you start to feel hopeless, you can call 1323, Thailand's free 24-hour mental-health hotline (Thai language; ask for English support).

Age-related conditions: heart and bones

As people with HIV live longer, long-term conditions become the main concern. A global analysis (Circulation 2018) found that people with HIV have about twice the risk of cardiovascular disease of the general population, because of chronic inflammation, smoking and other factors. Thinning bones and osteoporosis are also more common, especially in the first period after starting treatment and with regimens containing tenofovir disoproxil (TDF). Your doctor may recommend vitamin D, calcium, weight-bearing exercise, and a bone density scan if you are 50 or over or have other risk factors.

U=U and quality of life

The PARTNER2 study, in nearly 800 gay male couples, found no transmission at all from partners whose virus was suppressed to undetectable. So U=U is not just a medical fact; it reduces fear and stigma, and helps many people feel confident about love, intimacy and planning a family.

Your yearly monitoring checklist

• Viral load at least once a year when it is well controlled, and CD4 as your doctor advises
• Kidney function and urine, blood pressure, blood sugar, cholesterol and weight
• Liver tests, hepatitis B and C, syphilis and other STIs according to your risk
• Cervical or anal cancer screening, bone health and screening for depression
• A flu vaccine every year, and a review of smoking and alcohol

If you or someone you love has just received a result

You do not have to decide everything in one day. The first thing to do is get into treatment as soon as possible. Who to tell, and when, can be thought through gradually. Read Living with HIV and non-judgmental services as well.

At Dr. Kris Clinic in Surat Thani, I offer private counseling after a diagnosis, explain the treatment plan, help coordinate entry into the free treatment programme you are entitled to, or appropriate private care, and look after your overall long-term health, including the heart, hormones, sexual health and mental health. Consultations are available at the clinic and online nationwide, and English-speaking consultations are available.