The past two decades seemed to be surprisingly optimistic regarding life expectancy for people living with HIV. Those found with HIV can nowadays live almost a casual life and expect it to be a long-lived one, provided that the combination of proper treatment and a healthy lifestyle is present. A recent study suggests that a person diagnosed with HIV at the age of 20, could add up to 43.3 years of life to their life expectancy. However, insufficient treatment or treatment noncompliance could be deadly quicker than expected. Generally speaking, the goal of the treatment is to suppress HIV as much as possible. What we want to achieve is an almost undetectable HIV in the blood serum of a patient. To do that, patients should comply with their antiretroviral treatments and cooperate with their healthcare providers and consultants.

Although in 1996, life expectancy for an HIV-positive 20-year-old person was 39 years, in 2011 it was about 70 years.

How many people live with HIV?

Almost 1.1 million people living with HIV is estimated in the US alone. However, fewer and fewer are getting the virus anew annually. Decreased viral transmission might be due to several reasons. Firstly, treatment improvement has led to significant viral suppression in the blood, meaning that the virus is almost undetectable and hard or impossible to be transmitted sexually. Secondly, the general education of the population over sexually transmitted diseases has probably led to better individual protection against not only HIV but various other conditions. Finally, increased testing has potentially led to early diagnosis as well.

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Current treatment options and improvements

Antiretroviral medication is the mainstay treatment against HIV. It prevents the virus from reaching stage 3 or even developing into AIDS. Antiretroviral medication is the kind of therapy that every healthcare provider would suggest. It consists of a combination of antiretroviral drugs that the individual must take daily. These drugs' mechanism consists of lowering the viral load, meaning the viral levels in the blood. In other words, antiretroviral therapy suppresses the virus and prevents its progression.

But what does a decreased viral load mean?

A lower viral load in the blood of a person with HIV provides the individual with a greater life expectancy and an improved quality of life. Also, it prevents the disease from reaching stage 3 HIV, and it lowers the chances of sexual transmission, according to the 2014 European PARTNER study. Treatment as prevention became a whole new concept that focused on HIV treatment against its sexual transmission.

Antiretroviral drugs consist of the following classes:

  • non-nucleoside reverse transcriptase inhibitors
  • nucleoside reverse transcriptase inhibitors
  • protease inhibitors
  • entry inhibitors
  • integrase inhibitors

HIV treatment options in the future

However, researchers have not stopped here. Recent studies focus on finding a cure for HIV. In 2020, the market expects a monthly and very promising injection that consists of the drugs cabotegravir and rilpivirine. This injection will be as effective as a combined oral antiretroviral treatment, but also less engaging.

Long-term complications of HIV

As people with HIV tend to live longer, their health might become essentially affected by the virus and the disease itself or even by the side effects of the treatment. Some of the symptoms and signs individuals with HIV might experience are the following:

  • cognitive impairment
  • lipid metabolism disturbances
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Also, people with HIV are prone to:

  • inflammatory reactions and states
  • cancer
  • rapid aging

Treatment noncompliance or insufficiency may lead to stage 3 HIV or even AIDS. In stage 3 HIV, the immune system is exhausted and can no longer protect the individual against other pathogens. AIDS (acquired immune deficiency syndrome) is a chronic condition that is nonreversible and potentially lethal.

In the long-term, people with HIV become targets for opportunistic infections. Opportunistic infections are the type of infection that wouldn't casually affect a healthy person. The pathogens responsible for these infections are commonly part of the microbial flora of the human body and can cause serious complications to individuals with HIV. An example of such a pathogen is gut bacteria. An opportunistic infection is a sign of disease progression.

Examples of opportunistic infections include:

  • tuberculosis (TB)
  • pneumonia and various lung infections
  • salmonella and chronic intestinal infections
  • herpes simplex virus (HSV) and various neurocognitive disorders
  • fungal infections
  • cytomegalovirus infection

What is the best way to prevent complications?

The cornerstone of HIV-related complications prevention is starting on antiretroviral treatment early and staying engaged in the treatment plan. Besides, regularly consulting a physician is very important in preventing complications. In other words, early viral detection by routine HIV screening is probably the best preventive strategy.

As in almost any medical condition, lifestyle interventions are crucial in maintaining a healthy living. Guidelines set out by the Centers for Disease Control and Prevention (CDC) suggest there is no specific diet or exercise plan a person with HIV should follow as long as it is healthy and balanced. Aerobic exercise and resistance training seem to be the mainstay of longevity.

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How can HIV affect relationships?

The first thing to do when diagnosed with HIV is thinking about how to reveal it to your social circle and family or partner. Revealing to someone you're HIV positive might be a challenging thing to do. However, treatment progression has made the virus almost undetectable, meaning that sexual transmission is impossible. Your healthcare provider will consult you on what is the best way to reveal your condition. You might be required to attend mental health counseling. However, HIV positive people can maintain healthy sexual relationships with those who are HIV negative, not only due to the low viral load but also because of condoms. Pre-exposure prophylaxis (PrEP) medication can further reduce the risk of HIV even more in those without HIV.

In conclusion, recent anti-HIV treatments are so effective that can provide an individual with a long and healthy life. The secret to longevity is early diagnosis and effective treatment. Longevity is the result of protection against HIV-related complications. Lifestyle interventions are crucial and should consist of regular exercise and a healthy diet.