Our understanding of HIV and its treatment has come a long way since the first cases of the virus were reported in the population. Although HIV can be a potentially life-threatening illness, the good news is, advances in treatment have increased life expectancy dramatically and have made the condition manageable. However, in order to see the benefits of treatment, it’s important to be adherent and follow your healthcare provider’s instructions as best as possible.
As we learn more about HIV and how to treat it, we’ve developed highly effective medications that have changed what it means to live with HIV. HIV is no longer a life-threatening or ending diagnosis for those who are committed to treating the virus. Although HIV is still a chronic or long-term illness, it can be manageable. Without treatment, however, the virus can progress to its most advanced stage, AIDS (acquired immunodeficiency syndrome) in roughly ten years. For some untreated or non-adherent individuals, this progression may vary and can be shorter or longer.1
The importance of treatment
Regular and consistent treatment is important in controlling HIV for several reasons. Specifically, skipping doses or not taking HIV medications as prescribed can lead to a decreased amount of these medications in the bloodstream, allowing HIV to replicate and become more severe. When HIV is untreated and allowed to multiply in the body, it attacks immune cells called CD4 cells (also called T cells). These cells play an important role in helping us fight off illnesses and foreign invaders. With few to no CD4 cells, the body can be vulnerable to life-threatening conditions, such as cancers, fungal infections, other viral infections, and more. These illnesses can then lead to mortality.2-4
Another reason that consistent treatment is important is to prevent the mutation of HIV as much as possible. When HIV replicates in the body, it has the potential to mutate or change itself. When HIV mutates, certain medications may not fight the virus as effectively. If HIV continues to mutate, fewer and fewer treatment options may be effective against it, speeding up the progression of HIV.2,3 When treatment is taken as directed every day, the virus can be suppressed enough that mutations, and treatment failures, become rare. Treatment for HIV should be started as soon as possible after an HIV diagnosis is made.
HIV life expectancy
Life expectancy with HIV has increased significantly with the use of ART medicines (antiretroviral therapy). Some recent studies have suggested that for an individual with HIV who takes their ART as directed, life expectancy is approaching, or even the same as, the general population.5-7 This is especially true for more developed countries like the United States.7 Individuals with the greatest increase in life expectancy are typically those who start consistent treatment early on, have higher education levels, and those who don’t smoke or who quit smoking.8 However, anyone who is dedicated to treatment and who maintains regular appointments with their healthcare team, regardless of their background, can increase their life expectancy with HIV.
Reasons for not adhering to treatment
There are several reasons why an individual may have a hard time taking treatment exactly as directed. Several of these include a lack of consistent medical care or a healthcare provider, a lack of healthcare insurance to cover treatments and appointments, frustration with the pill burden of HIV (some treatment regimens require multiple pills to be taken every day), side effects, and more.
This is why it is incredibly important to find a healthcare provider that you can check-in with regularly throughout treatment about any obstacles you face. There may be resources they have access to that can help, or they may be able to adjust your treatment plan. They may even be able to give you tips on how to combat some common treatment side effects such as fatigue, nausea, vomiting, diarrhea, headache, insomnia and more.9 Open communication and regular visits with your healthcare provider may help prevent obstacles before they come up.
Research update and the search for a cure
There is a lot of exciting and innovative research currently ongoing when it comes to HIV. Some efforts are focused on achieving HIV remission without the use of daily ART, while others are focused on eliminating all HIV from the body, even when it is inactively hiding within cells (also called being latent).10
Scientists are currently investigating ways to ramp up the immune system, including developing HIV-fighting proteins called antibodies or a potential HIV vaccine. Additionally, since needing to take pills every day may be a barrier to maintaining consistent treatment, some research efforts are focused on creating ART that is longer lasting, meaning it can be taken less frequently.11
Scientists are also currently looking into stem cell transplants and gene therapy in order to cure HIV. Some individuals possess a specific gene mutation that changes a protein on their cells’ surface called CCR5. CCR5 is used by HIV to enter its target cells and replicate. In individuals with a mutation that changes their CCR5, HIV may have a harder time getting into and infecting cells. Scientists have been investigating the use of stem cell transplants or gene therapy to get this specific gene into individuals who don’t normally have it, potentially stopping HIV from infecting their cells.12
One other interesting area of research focuses on the CRISPR/Cas9 system (clustered regularly interspaced short palindromic repeat/CRISPR-associated nuclease 9). This system allows genes to be “edited”, or changed, while inside living cells. CRISPR/Cas9 has been of interest to scientists studying HIV because of its ability to potentially “delete” or inactivate HIV genes that have inserted themselves into host cells and are hiding out.13-15 Much more research is needed to determine the effectiveness of these potential HIV treatment options; however, this area of study is growing daily.
