First, I should tell you that each and every one of the professionals on this site that work so hard to add a voice of reason to an otherwise very confusion situation are worth your weight in gold. Thank you.

I am a 40 year old man newly diagnosed with HIV. I am a professional; dont smoke cigarettes, and only drink in moderation. My Doctor does not feel it is time to begin medication because my numbers are all near normal. I dont NOT have co infections such as Hep. A, B or C and I dont have diabetes (thank goodness).

I am the type of person who is extremely able to adhere to medications and have access to an excellent HIV Doctor and medication. Do you think it is reasonable to assume that can live a normal life span (providing I dont get hit in the head with a coconut or other circumstance beyond HIV)? I read conflicting things on life span from 10 years to a normal life span. Please tell me what prognoses for the future that you would tell one of your patients in a similar circumstance. Thank you and look forward to your answer.

I tell my patients who have just been found to have HIV that there IS a chance of a normal life expectancy, and that that chance has been getting greater with each passing year, as the risk of antiretroviral therapy failures has decreased in the past 10 years.

So that's the good, optimistic news. And of course I inform them that this will not be easy, even in the best of circumstances. Adherence to daily medications is extremely demanding, even if there are no untoward side effects. Life with HIV is still a hard life, even if the medication part becomes simple and routine, as it does for a remarkable percentage of patients these days.

I prepare patients for a life long struggle with adherence, in part to be sure to get their attention at the outset, but also from long and hard experience, it is for many patients who perfectly fit the profile that you describe. If it turns out to be easier than expected, thats great...but lapses in adherence often result from complacency and a sense that 'I've got everything covered'. So some vigilance is required.

But there is still harder news in that first encounter. A patient may do everything right, with exemplary perfect adherence...and still have trouble with ART, virologic failure, resistance mutations, and a difficult sequence of ART. Fortunately these are uncommon events in this era, but they still do occur.

I appreciate your coconut comment as well, as any one of us may obsess over one illness (maybe HIV, maybe diabetes, maybe cancer) only to walk in front of a bus. Its a reminder to enjoy life on this day, because none of knows what tomorrow will bring.

In sum - there was a modeling study of a 40 year old male with a story similar to yours and new HIV infection, the outcome of which was a reasonable chance of a normal life expectancy in the event of positive outcomes with antiretroviral therapy. I tell all new HIV positive patients about that study. And then I also tell them the possibilities for the outcomes that are less than the best.