The life expectancy of a person living with HIV has improved dramatically over recent years. Thanks to advances in antiretroviral therapy (ART), many people living with HIV can now live long lives.

When first reports of HIV and AIDS began in the 1980s, HIV was a life threatening condition. However, people can now manage HIV as a chronic health condition as long as they continue their treatment.

In this article, we examine the life expectancy of people living with HIV, developments in managing and treating HIV, and the long-term outlook.

Two people holding hands, one older and one younger, against a black background.Share on Pinterest
dszc/Getty Images

Here is what research says about life expectancy for those living with HIV, both with and without treatment.

With treatment

Life expectancy for those with HIV who have access to medical care and who take long-term ART is positive.

A 2022 cohort study evaluated the data of 200,000 people with HIV in Europe and North America from 2015 onwards who were taking ART. The researchers found that those undergoing long-term HIV treatment and who had high CD4 counts had lifespans similar to that of the general population.

CD4 is a type of immune cell in the body. HIV attacks and destroys these cells. As a result, a high CD4 count means the immune system is functioning well.

However, the cohort study found that people with low CD4 counts lived up to 30 years less than the general population. Low CD4 counts may indicate HIV is progressing. This could be because of interruptions in treatment or because a person’s regimen is not working as well as it should.

This highlights the need for consistent medical care and monitoring of HIV viral load so that clinicians can adjust treatment where necessary.

Without treatment

Life expectancy is dramatically lower for people with HIV who do not receive any treatment. The Centers for Disease Control and Prevention (CDC) states that once people receive an AIDS diagnosis, they typically live for 3 years.

In the early years of the HIV epidemic, when no treatments were available at all, many people only lived around 1–2 years after receiving a diagnosis.

The increase in life expectancy for people living with HIV is due to improvements in treatment.

In the 1980s–1990s, antiretroviral therapy began as monotherapy, then it became dual therapy. Now, there is combination ART, which includes three or more drugs that each attack HIV in different ways.

A 2017 study in Switzerland showed the difference these developments have made. The authors estimate that the additional life expectancy for people with HIV at age 20 during the early monotherapy era was 11.8 years. However, that number rose to 54.9 years with recent combination ART started between 2006–2013.

Although HIV treatment is much more effective today than it used to be, researchers are still investigating a cure. In the meantime, combination ART can preserve health by suppressing the amount of HIV in the blood.

If the viral load drops below a certain threshold, HIV becomes undetectable. When this happens, the risk of transmitting HIV through sexual contact is zero.

ART also reduces the risk of transmission through pregnancy and childbirth to less than 1%. There is still a potential risk of transmission through breastfeeding and needle sharing, but it is substantially less.

HIV and AIDS resources

For more in-depth information and resources on HIV and AIDS, visit our dedicated hub.

Was this helpful?

Without treatment, HIV can quickly start to damage cells in the immune system. It progresses in stages. They are:

  • Stage 1: Stage 1 HIV is also known as the acute phase. It often begins with flu-like symptoms, although some people do not have any symptoms at all. There is a high amount of virus in the blood, and it is easy to transmit to others.
  • Stage 2: Stage 2, or the chronic phase, causes no symptoms. However, the virus continues reproducing, and people can still transmit the virus.
  • Stage 3: Stage 3 HIV is also known as AIDS. This occurs when virus levels are high enough in the blood that a person’s immune system cannot protect them against infections.

As it progresses, HIV can lead to:

  • serious viral, bacterial, or fungal infections
  • the reactivation of viruses that are dormant in the body, such as herpes viruses
  • significant involuntary weight loss, or wasting syndrome
  • certain cancers, such as lymphoma

Medication side effects

While HIV treatment is life saving, antiretroviral medications can still have short- and long-term side effects. However, not everyone experiences side effects, which tend to be less intense than they used to be.

The most common side effects include:

  • nausea and vomiting
  • diarrhea
  • insomnia
  • headache
  • dizziness
  • dry mouth
  • rash
  • pain
  • fatigue

Sometimes, side effects only occur when a person begins a medication and may go away after a few days or weeks. Most side effects are manageable, but if they become severe or cause someone to want to stop taking ART, they need to speak with a clinician.

Long-term ART can increase the risk of certain conditions. The effects will vary depending on the drugs a person is taking but could include:

Because it is still a fairly recent outcome that people with HIV live for longer, scientists are still learning about the effects of long-term ART and how to prevent them. However, the benefits of these drugs usually outweigh the risks of not taking them.

ART has dramatically extended the lives of people living with HIV. Because of this, those with the infection can experience the same health issues as other older adults.

The virus may also affect health and aging, even with treatment. Older people with long-standing HIV infections can develop associated health conditions, such as:

  • cardiovascular disease
  • diabetes
  • kidney disease
  • cancer

This may be due to a variety of factors, but chronic inflammation due to HIV itself could be one of them.

HIV and its treatment can also affect the brain, causing a condition known as HIV-associated neurocognitive disorder (HAND). Differentiating Alzheimer’s disease from HAND is an emerging issue in the population of older adults living with HIV.

Research into these effects is ongoing. For now, it is important for those living with HIV to stick to their treatment plan to keep the virus suppressed and to be proactive in looking after their health.

The outlook for people with HIV has greatly improved since the epidemic began. With long-term treatment, many of those with the infection have a similar life expectancy to the rest of the population. This improvement is due to advances in drug therapy.

Researchers are still investigating further HIV treatments and possible cures. Until then, people with HIV must have access to and continue to take ART. This protects their health and also lowers the risk of transmission.

HIV may still affect health, even with treatment. A person needs to work closely with medical professionals to monitor their condition and all other aspects of their health and well-being, wherever possible.