How Long Can You Live with HIV?
You can have a normal lifespan but need to manage health challenges
Medically reviewed by Ronald Lubelchek, MD
People with HIV can expect to live a near-normal life expectancy if diagnosed and treated early. With advances in antiretroviral therapy, people living with HIV can expect to live longer and healthier than ever before if treatment is started at the time of diagnosis and taken as prescribed.
With that said, there are many factors—some you can change and others you can't—that can take back those gains and shorten a person's life expectancy. These include modifiable risk factors like smoking and injecting drugs and non-modifiable risk factors like race and gender.
At the same time, non-HIV-related conditions like diabetes, heart disease, and cancer are more common in people with HIV, making it all the more important to reduce your risk for those diseases in order to live a longer, more healthy life.
This article looks at what the current research says about HIV and life expectancy. It also explores some of the factors that influence life expectancy and what you can do to remain healthier longer if diagnosed with HIV.
Illustration by Michela Buttignol for Verywell Health
Changes in Life Expectancy with HIV
At the time of the introduction of highly active antiretroviral therapy (HAART) in 1996, the average life expectancy of a 20-year-old newly infected with HIV was 10 years from the time of diagnosis. This new drug strategy—which involved the combination of multiple drugs of different classes—proved so effective that death rates rapidly dropped and life expectancies rapidly increased.
According to a landmark study from the North American AIDS Cohort Collaboration on Research and Design in 2013, a 20-year-old starting HIV therapy could expect to live to their early 70s.
That figure was confirmed in a 2023 review published in Lancet HIV in which the average life expectancy was reported to be anywhere from 70.8 years to 74.6 years for a 20-year-old newly diagnosed with HIV in North America and Europe.
With the life expectancy of the general U.S. population hovering at 77 years, this means that people treated early for HIV can enjoy near-normal lifespans. Some individuals can expect to live even longer.
How to Increase Life Expectancy
When looking at the current body of research, there are shared characteristics in people who live full, healthy lives with HIV. Chief among these is consistent medical care.
HIV requires lifelong treatment and lifelong adherence to antiretroviral therapy. In short, you need to get your blood tested several times a year to ensure that the drugs are working and to proactively check for any illnesses or side effects that may be developing. You also need to get your prescription renewed and refilled on time to avoid any gaps in treatment.
Studies have shown that continuous HIV-specific care independently reduces the risk of AIDS-related death by 21%.
There are three other things you can do to live a long, healthy life if recently diagnosed with HIV.
Start Treatment Early
HIV treatment is most effective when started during the early stages of infection when your CD4 count is high.
A CD4 count is a test that measures the number of CD4 T-cells in your blood. These are the white blood cells that HIV targets for infection, gradually killing off more and more over time. The CD4 count—which ranges from 0 to 1,300 or more—is an indication of how strong your immune system is.
Starting treatment when your CD4 is above 200 increases the chances that your CD4 count will return to normal levels (500 or above). On the other hand, the CD4 count may never fully recover if treatment is delayed, leaving you vulnerable to a wide range of opportunistic infections (which occur in people with weakened immune systems).
Delayed Treatment Reduces Longevity
Studies have shown that starting HIV therapy with a CD4 count under 200 reduces life expectancy by an average of eight years compared to someone starting at a CD4 count over 200.
Stop Smoking
Studies have shown that smokers living with HIV lose more life-years to smoking than any other single cause. Moreover, the risk of death from smoking is twice as high among smokers with HIV, trimming an average of 12 years from their lifespan.
According to research published in Clinical Infectious Diseases, a 35-year-old smoker living with HIV had a median life expectancy of roughly 63 years.
Do Not Use Injectable Drugs
Injecting drug users with HIV suffer a loss in life years as a result of both HIV- and non-HIV-related illnesses. Due to lower rates of treatment adherence, the risk of severe opportunistic infections is far higher among people with HIV who inject drugs than those who don't.
People who inject drugs are also more likely to be co-infected like hepatitis C and other bloodborne infections that can further cut life expectancy.
Research suggests that people with HIV who inject drugs may lose as many as 13.6 years compared to those who do not inject drugs.
Related: Facts About HIV Risk in Latinx Communities
Factors That Affect Life Expectancy
Despite advances in diagnosis and treatment, there are factors that can increase or decrease the life expectancy of people living with HIV. These range from factors that can be controlled (like taking your pills every day) to things that can't (like race, poverty, or even genetics).
Race
Race and longevity in people with HIV are integrally linked. This is due in large part to disparities in wealth between people of different races or ethnicities. There is no clearer picture of this than the poverty rate among Black people in the United States which is twice as high as the rate seen in White people (17.1% versus 8.6%).
Poverty and poor access to healthcare are not the only factors drawn along racial lines. Stigma, the failure of public health systems, low health illiteracy rates, and language barriers are also common themes. All of these translate to lower life expectancy if you have HIV.
This is strongly evidenced by studies involving men who have sex with men (MSM) who account for the lion's share of HIV infections in the U.S. According to a 2023 study published in JAMA Open Network, Black MSM with HIV live an average of 6.8 years less than White counterparts due to the intersection of poverty, racism, stigma, and healthcare discrimination.
Related: The High Risk of Gay Black Men Getting HIV
Socioeconomics
Poverty complicates every aspect of HIV diagnosis, treatment, and prevention. Without access to quality healthcare, insurance, housing, or employment, a person is not only more vulnerable to HIV but less likely to manage their disease effectively.
Poverty is also associated with higher rates of crime, substance abuse, incarceration, food insecurity, and social isolation, all of which affect health outcomes in people living with HIV. And, this is a problem given that nearly three out of four people living with HIV in the U.S. live at or below the poverty line.
Low socioeconomic status affects a person's ability to access treatment, pay for treatment, or maintain an undetectable viral load (a measure of sustained viral control). In the absence of these elements, life expectancy will almost invariably decrease.
Studies suggest that women with HIV who live below the poverty line are 5.7 times more likely to die prematurely than counterparts who live above the poverty line.
Gender
Females with HIV tend to live longer than males with HIV in the same way that females tend to live longer than males in the general population.
Research published in Lancet HIV reported that among 206,891 people living with HIV in the United Kingdom, females lived to an average age of 75.8 years while males lived an average of 74.5 years.
Many of the same factors affecting male and female longevity in the general population may influence longevity in people with HIV. With that said, other biological factors may also play a role, some of which are poorly understood.
For example, studies have shown that the viral load of untreated females with HIV is up to 40% lower than in males due to the stronger activation of the immune system. After treatment, females have a lower risk of progression to AIDS even though they generally have lower rates of treatment adherence.
Genetics
Genetics may also play a key role in HIV life expectancy. Among people living with HIV, there is a subset called long-term non-progressors (or "elite controllers") who are able to control the virus without antiretroviral drugs. As many as one of every 200 people with HIV is thought to have this innate immune protection.
Elite controllers are known to produce immune cells called broadly neutralizing antibodies (bnAbs) that can control a vast range of genetic variants of HIV that a normal immune system can't.
Because of this, many elite controllers are able to live normal life spans without treatment. A 2022 study from Spain reported that after 30 years of surveillance, only two out of 313 elite controllers died of an AIDS-related condition.
How HIV Affects You as You Age
With age, health concerns about HIV extend beyond just HIV-related illnesses. Even if HIV treatment is successful, the risk of non-HIV-associated diseases—like cancer or heart disease—is exponentially greater than that of the general population.
So serious are these concerns that a person living with HIV today is far more likely to die prematurely of a non-HIV-related illness than an HIV-related one.
Risk of Chronic Disease
Even when HIV is treated, the infection places your body under constant, low-level inflammation. Over time, this can cause changes to vital organs that prematurely "age" them, leading to the onset of chronic diseases 10 to 15 years earlier than the general population. The risk is greatest in people who are inconsistently treated and have detectable viral loads.
These include chronic conditions like:
Cardiovascular disease: HIV independently increases the risk of heart diseases (including heart attack, stroke, and heart failure) by anywhere from 50% to 100%.
Cancers: Non-HIV-associated cancers like melanoma, lung cancer, and liver cancer occur at a rate four to eight times greater than the general population, while Hodgkin lymphoma and anal cancer occur at a rate 41 and 124 times greater.
Diabetes: People with HIV are up to four times more likely to have type 2 diabetes. To complicate matters, certain HIV drugs (like protease inhibitors) make blood sugar harder to control.
People living with HIV can reduce their risk by taking the same steps as anyone else to prevent heart disease, cancer, or diabetes. This includes changes in diet, regular exercise, routine health screenings, and taking medications like statin drugs or metformin when needed.
Drug-Induced Kidney and Bone Disease
It is important to note that certain antiretroviral drugs are associated with an increased risk of kidney dysfunction and osteoporosis. Chief among these is tenofovir found in the drugs Truvada, Descovy, Viread, Complera, Stribild, Atripla, Delstrigo, Symfi, and Symfi Lo.
It is for this reason that people on tenofovir need to have their blood routinely checked with kidney function tests. Males 50 and older, postmenopausal females, and people at high risk of falls should undergo a bone scan and discontinue tenofovir use if bone loss is significant.
HIV-Associated Neurocognitive Disorder
Over time, chronic inflammation caused by HIV can affect the brain and lead to a condition known as HIV-associated neurocognitive disorder (HAND). Symptoms of HAND often start subtly but become progressively more apparent, causing:
A loss concentration
Poor memory
Impaired thinking
Slow movement
Depression
Irritability
Tremors and twitches
Muscle spasms
Neuropathy (pins and needles sensations)
In severe cases, HIV encephalopathy (a.k.a. "AIDS dementia") can develop, manifesting in a serious loss of cognition and memory.
HAND is the consequence of long-term HIV infection and is easily mistaken for other forms of cognitive decline. Up to 40% of people with HIV experience some degree of HAND even with treatment. Sustained viral suppression greatly reduces the risk.
Respiratory Infections
According to the Department of Health and Human Services, people with advanced or untreated HIV are at risk for more severe illness from respiratory infections like COVID-19.
However, unlike some high-risk groups (such as people with asthma or heart disease), the treatment of HIV appears to reduce the risk of complications by bolstering the immune response. It is only people who are untreated, have a high viral load, or have a CD4 under 350 who are at high risk of severe COVID complications.
While there is no evidence that HIV places you at greater risk of getting respiratory infections like influenza (flu) or respiratory syncytial virus (RSV), people with advanced or untreated HIV are at greater risk of severe complications like pneumonia if they do get it.
Fortunately, there are vaccines for COVID, influenza, RSV, and a communicable bacterial lung infection called pneumococcus that can greatly reduce the risk of infection or severe complications if you do get infected.
Quality of Life
Even with newer drugs offering fewer side effects and simpler dosing schedules, people living with HIV still face significant challenges over the long term.
Even with excellent adherence, antiretroviral therapy can eventually fail and require a whole new set of drugs, some of which may be less tolerable. The cost of ongoing care and treatment can cause financial burdens and undue stress.
Moreover, the impact of stigma—which affects 82% of people living with HIV—can lead to social isolation that reduces not only the quality of life but also the ability to adhere to treatment.
Dealing with these concerns is seen to be just as important as getting a viral load to undetectable levels.
Related: Advocating for HIV Care
HIV Diagnosis in Older Adults
Older adults are more likely than younger adults to be diagnosed with HIV in the late stages of the disease, often when the immune system is compromised and the CD4 count is below 200 (the clinical definition of AIDS). For many in this situation, the diagnosis is made only after a person has had their first major opportunistic infection.
The problem with this is that older age and a low CD4 count at the time of diagnosis decrease the odds of restoring your CD4 count to normal levels. This, in turn, can affect your long-term survival.
Because HIV is often symptom-free until severe illness occurs, the U.S. Preventive Services Task Force recommends the once-off testing of HIV for all Americans ages 15 to 65 as part of a routine medical visit.
Testing is especially crucial if you have risk factors for HIV, such as a history of multiple sex partners, condomless sex, or injection drug use.
Late Diagnoses in Older Adults
According to a 2023 report from the Centers for Disease Control and Prevention, 34% of people aged 55 and older already had late-stage HIV infection (AIDS) at the time of their diagnosis.
Reducing the Risk of Developing AIDS
The best way to avoid a diagnosis of AIDS is to start antiretroviral therapy. This involves two or more drugs used in combination that block stages in the virus' life cycle. By doing so, the virus cannot make copies of itself, and the viral population can be reduced to undetectable levels where it can do the body little harm.
Most antiretroviral therapies come in pill form. Many are fixed-dose combination drugs that combine multiple antiretrovirals, reducing your dose to as little as one pill per day.
Dosing has even been made simpler with the introduction of Cabenuva, an antiretroviral therapy requiring two injections in the buttocks every two months.
Even if your diagnosis is delayed, it still benefits your health and longevity to start treatment immediately. If your CD4 count is low, your healthcare provider can prescribe prophylactic (preventive) drugs that help reduce the risk of different opportunistic infections.
How Long Can I Live Without Treatment?
According to a 2021 study in the Journal of the International AIDS Society, the average life expectancy for an untreated 24-year-old with HIV is 12.5 years, and 7.2 years for an untreated 45-year-old with HIV. Once AIDS is diagnosed, an untreated person will live for approximately three years.
Fortunately, with appropriate treatment, a person with HIV may never develop AIDS or severe HIV-related complications.
Related: How HIV Is Treated
How to Get Support
Ensuring the longest possible life with HIV requires a commitment to therapy. This means taking your pills every day, making sure your prescriptions are refilled, and staying linked to consistent medical care.
If there are social, psychological, or financial barriers standing in your way, speak to your healthcare provider or reach out to support services offered by community-based HIV services and federal or state providers.
These include:
Ryan White HIV/AIDS Program Medical Provider tool to search for HIV care and support services
Your state's HIV/AIDS Hotline for advice, referrals, information, and support
Common Patient Assistance Program Application to apply for HIV medicines at little or no cost
It also helps to build a network of friends and confidants to support you or to join an HIV support group available online or in person.
Related: HIV Support Groups
Summary
Studies show that people living with HIV today can expect to live a near-normal life expectancy if treatment is started early and taken every day as prescribed. Even so, there are things that can undermine a person's ability to do so.
This includes factors like poverty, stigma, and racism that can stand in a person's way of accessing care and treatment. Other behaviors like smoking and injecting drug use are directly linked to a loss of life years. Delayed treatment also reduces life expectancy because the immune system is less likely to recover, leaving the body vulnerable to infection.
Starting treatment early, staying on treatment, seeing your healthcare provider regularly, and maintaining a healthy lifestyle contribute to living a long life with HIV.
Read the original article on Verywell Health.
