HIV, the New Chronic Illness

Just thirty-odd years ago, a HIV diagnosis was a death sentence. Advances in pharmaceuticals and in our understanding of the mechanisms of HIV infection mean that today it is a manageable, chronic disease on par with diabetes, hypertension, and cardiovascular disease. People with HIV are living longer, and a graph recently published by the Centers for Disease Control and Prevention (CDC) shows that in the United States the average age at death from HIV infection has dramatically increased since 1987. (1)

For men, the average age at death has increased 34% from 37.9 years of age in 1987 to 50.8 years in 2013. For women, the improvement is even more dramatic – the average age at death increased by 41.2% from 35.2 years in 1987 to 49.7 years in 2013.

A good life expectancy for HIV-positive patients requires timely initiation of medical treatment, as well as access and committed adherence to long-term therapy and medical care. As demonstrated in an article published last year in the journal AIDS, HIV-positive individuals that started anti-retroviral therapy even with a low CD4 T-cell count – an indicator of a depressed immune system – significantly improved their life expectancies by both reducing their viral load and also increasing their CD4 cell count, evidence of an immune system recovering and controlling the viral infection. (2)

Two years ago, in an article on HIV infection as a chronic illness in The Lancet a group of physicians wrote, “AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life.” (3) For people with HIV, their concern now becomes the health conditions that must be managed as a result of having an immunodeficiency or as a side effect of taking anti-retrovirals. This can include an increased risk of cardiovascular disease and heart attacks, as well as certain types of cancers and neurological diseases.

For an infection that once had a life expectancy measured in months, a HIV-infected individual can expect to live for decades when treated appropriately. This extraordinary improvement in longevity is a testament to our advancements in the treatment and management of HIV, from discoveries and developments in anti-retroviral drugs, treatments for opportunistic infections, and insights into the pathophysiology of this fascinating virus.

References

(1) [No authors listed] (2015) QuickStats: Average Age at Death from HIV Disease, by Sex – United States, 1987-2013. MMWR Morb Mortal Wkly Rep. 64(43): 1228.

(2) MT May et al. (2014) Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS. 28(8): 1193–1202

(3) SG Deeks et al. (2013) The end of AIDS: HIV infection as a chronic disease. Lancet. 382(9903): 1525-33

By Rebecca Kreston | November 24, 2015

Source: http://blogs.discovermagazine.com/