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HAART and life span
May 22, 2001

How long, on average, do antiretrovirals prolong a person's life and what are the main reasons that they will stop working.

Response from Dr. Young

Thank you for your question.

This is a difficult question to answer with precision. Prior to antieretroviral therapy, the average time to progression to AIDS after HIV infection was about 8-10 years. However, it is important to recognize that some people progressed very rapidly (taking about 5 years), and a very lucky few (around 1 percent or less) had very slow or no disease progression.

Since the advent of combination therapies, we have all seen the life expectancy and quality of life for PWAs improve dramatically. In the US HOPS study, Palella has shown that the death rate has gone from 30/100 person years for those with advanced AIDS to around 5/100 person years. One would be tempted to say that the life expectancy has gone from 3 to around 20 years. This is not wholy accurate, for a variety or reasons, particularly given the difficulty in maintaining strict adherence to HIV medications over this period of time. Indeed, the same analysis showed that the average lifespan of a combination therapy in the general population was only 15-18 months- we have a long way to go before we can realize decades of treatment survival.

Drug regimens typically fail for two reasons- either because of drug resistance or because of side effects and toxicities. Drug resistance occurs through the use of inadequately potent regimens (this can happen either because of preexisting resistance, or because of missed doses of medications). Once established, drug resistance can set the stage for the development of cross resistance, or multi-drug resistance. Certain side effects or toxicities can also limit the functional life span of treatment regimens. Here, it is very important to sort out what the side effect or toxicity is, and whether the symptoms is the direct effect of the medication. If the later is true, it may be possible to simple change the offending drug for another drug of the same class. So-called switch clinical trials have been studied, in general terms, if done when the person's viral load is undetectable, are safe.

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