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Do we really have fifty years together?
Mar 15, 2002

I'm in love with an HIV positive man; I am HIV-. He's in his forties, I'm 36. In order marry him, I need to make some drastic geographical, career, and other changes which will have a major impact on my life. I am willing to marry him as long as I have a clear understanding of what our future together looks like. He was diagnosed three or four years ago, and tells me he'll be around in fifty years. I have been educating myself, but am uncertain about his true prognosis. He is on a wonderful treatment program and takes exemplary care of himself. Please clarify: upon learning one is HIV positive, what can one assume about the future/life span? I've read that between ten and fifteen years after diagnosis, complications will have begun. Is it naive of me to think we might have a long life together? I want to know, realistically, what to expect.

Response from Dr. Remien

The problem is that one cannot make any truly valid assumptions about future life span, once diagnosed HIV+, at least not any assumptions that apply to all people living with HIV. Even before effective therapies were available there was a wide range of illness course and longevity among people living with HIV. Now that there are effective therapies more and more people are indeed living much longer without significant illness, decline, or death. So while HIV is not a desirable thing to have and there is the risk of immune decline and occurrence of opportunistic illnesses, it is not unreasonable to anticipate a very long and healthy life with a "normal" life span.

As I understand it, the ten to fifteen year statistic you refer to is mostly based on long-term studies of people living with HIV before there were effective combination antiretroviral therapies. That is, without effective treatment approximately 50% or more of people living with HIV would show significant illness progression (with complications) in that time frame. Now that many people are responding to effective treatments (mostly only available since 1996) we do not really know what the long-term prognosis is for most people.

So, there is uncertainty about what lies ahead for this man that you care about. The most you have to go on is what you know of his current health status and the way he takes care of himself. However, it is not unreasonable to think that you will have a long life together, but of course there are no guarantees. However, the same can be said for everyone. It is certainly possible that you could become ill with a serious illness (not yet diagnosed) before he does and he would be the one caring for you. So, you will need to base your decisions on your feelings about this man and the relationship, the risks & benefits, as you see them, and proceed accordingly.


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