Dr. Wohl, I have seen many of the responses from other doctors but am curious on what your take is on life expectancy. Are you as optomistic as some of the other doctors that you can live a normal life with HIV? If not, do you expect the pipeline of new therapies to change that outlook?

I think that the prognosis for those living with HIV infection depends on many factors. Those presenting for care at an advanced stage (i.e. very low CD4 cell counts, opportunistic infections) have a tougher time recovering their health. Further, these individuals often have less robust responses to HIV therapy. That is not to say they can not acheive high CD4 cell counts and live to ripe old ages, its just more of a challenge to do so.

For those not in the more advanced phases of HIV, I do feel life expectancy can be on the order of decades rather than years. This hinges on partnership with a knowledgable clinician and health preserving actions on the part of the individual such as taking their medication in a way that will preserve their effectiveness and avoiding harmful substances such as crack and excessive alcohol use.

As you suggest, newer drugs pave the way for better outcomes.

I often compare what my patients have to do to acheive long term survival to the rigors of elite athletes: the right food, the right attitude, the right advice leads to the gold. It is not easy but the rewards are great.

DW