Joel Gallant, M.D., M.P.H.
One question that comes up often after an HIV diagnosis is "How long do I have to live?" Of course, the first thing you should hear from your doctor is that, with proper treatment and care, you don't have to expect a shorter life because of HIV. On his personal tumblr, Joel Gallant, M.D., M.P.H., an HIV doctor at Southwest CARE Center in Santa Fe, New Mexico, answers questions from people living with HIV who are concerned about a number of issues, including HIV diagnoses.
On Sept. 21, 2014, an anonymous user asked:
It has been well established that HIV accelerates the aging process by 10 to 20 years, even with treatment. My question then is what about those infected later in life, say 50s and 60s when their normal life expectancy is already within that range. Can they expect a greater or some sort of ratio in this acceleration in aging than say someone in their 30s-40s?
In fact, it has not been well established that HIV accelerates the aging process or reduces life expectancy even with treatment. In fact this is a subject of enormous controversy. There are a number of problems with studies that suggest this acceleration in aging. One is the use of inappropriate comparisons. For example, many studies compare data from inner city HIV clinics -- which may include poor minorities, HCV-coinfected people, and injection drug users -- with the general population. If the HIV-positive people die earlier, is it really because HIV is making them age faster, or is it because of other factors that have nothing to do with HIV?
An interesting study that does not suffer from this bias is a recent Kaiser study looking at the difference in risk of heart attack between HIV-positive and HIV-negative patients over time. They found that, while historically there had been an increased risk of heart attack in HIV-positive people, that difference has been shrinking over time and has now disappeared. The assumption is that we are using more "heart friendly" drugs to treat HIV infection and that we're being more aggressive at treating other conditions that could increase the risk. The fact that this study comes from Kaiser means that there's greater homogeneity than in some of the other comparison studies. In other words, the HIV-positive people are fairly similar to the HIV-negative people from a socioeconomic standpoint -- they all have jobs that allow them to enroll in Kaiser for insurance. This homogeneity makes the comparison much more meaningful.
There's no question that people with well-controlled HIV infection have somewhat higher levels of inflammation and immune activation than HIV-negative people, but their levels are still just a small fraction of what they would be if their viral loads weren't suppressed. There's a lot of discussion and debate about how much this ongoing inflammation and immune activation will affect longevity and quality of life during the aging process, but there's no evidence at all that it will reduce life expectancy by 10-20 years. In fact, there have been a number of studies from various countries that estimate that the life expectancy of an HIV-positive person with an undetectable viral load and a CD4 count about 500 is approximately the same as that of the general population.
Joel Gallant, M.D., M.P.H., is the associate medical director of specialty services at Southwest CARE Center in New Mexico. You can ask him a question directly on his Tumblr page, Ask Dr. Joel.
Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com. You can follow him on Twitter at @mathewrodriguez, like his Facebook page or visit him on his personal website.
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