ARV Treatment: How long can people living with HIV expect to live?

Thanks to advances in modern medicine – especially the advent of antiretroviral therapy (ARV) – HIV is no longer a “death sentence” if detected early and treated properly. So, what exactly is ARV treatment, and how does it work? What is the actual life expectancy of people living with HIV in the ARV era? What should be taken into account during ARV treatment?

What is ARV treatment, and how does it work?

What is ARV?

ARV stands for Antiretroviral Therapy, also known as retroviral therapy. It is a treatment method that uses antiviral drugs to control the replication of the HIV in the body. The main objectives of ARV treatment are to:

• Inhibits HIV: Prevents the HIV from replicating and attacking immune cells.
• Reduce Viral Load: Lower the amount of HIV in the blood to the lowest possible level (even below the detectable threshold).
• Restore the Immune System: Help the immune system – especially CD4 cells – recover and function more effectively in combating opportunistic infections.

How do ARV drugs work?

ARV drugs work by interfering with different stages in the HIV replication cycle. The primary groups of ARV drugs include:

• Reverse transcriptase inhibitors (NRTIs and NNRTIs): These drugs block HIV from copying its genetic material.
• Protease inhibitors (PIs) prevent HIV from producing the proteins necessary to assemble new viruses.
• Entry inhibitors: These prevent HIV from entering immune cells.
• Integrase inhibitors stop HIV from integrating its genetic material into the DNA of human cells.

Life expectancy of people living with HIV under ARV treatment

Current average life expectancy

A large study in 2022, which analyzed data from 200,000 people living with HIV in Europe and North America since 2015 and was published on MedicalNewsToday, revealed that individuals on long-term ARV treatment have a life expectancy comparable to that of the general population. Conversely, without treatment, the life expectancy of someone with HIV is usually around three years (according to the U.S. Centers for Disease Control and Prevention, CDC). This stark contrast demonstrates that ARV treatment has revolutionized the extension of life expectancy for people living with HIV.

How does ARV treatment extend life expectancy?

ARV treatment plays a crucial role in prolonging the life expectancy of those with HIV by:

• Controlling the HIV Virus: Inhibiting HIV reduces damage to the immune system, preventing progression to AIDS and dangerous opportunistic infections.

• Restoring the Immune System: A healthier immune system helps the body fend off diseases more effectively and reduces the risk of serious non-AIDS-related conditions (such as cardiovascular disease and cancer).
• Improving Quality of Life: People living with HIV who receive ARV treatment can lead healthy lives, work, study, and enjoy life just like anyone else.

Quality of life for people living with HIV on ARV treatment

ARV treatment not only extends life expectancy but also enhances the quality of life. With controlled viral load and a restored immune system, individuals with HIV can:

• Live actively and healthily: Engage in physical activities, work, study, and contribute to society.
• Build families and relationships: Get married, have healthy children (with measures in place to prevent mother-to-child transmission), and maintain normal social relationships.
  Reduce HIV transmission risk: When the viral load is undetectable, the risk of sexual transmission of HIV is almost zero (U=U – Undetectable = Untransmittable).

Factors affecting life expectancy in HIV patients on ARV

Although ARV treatment offers hope for a longer life, the actual life expectancy of each person depends on several factors, including:

Early detection and treatment

• Early Testing: Early HIV detection allows patients to start ARV treatment promptly, before the immune system is significantly damaged.
• Timely Treatment: Initiating ARV treatment right after an HIV diagnosis helps quickly control the virus, protect the immune system, and improve survival prospects.

Treatment adherence

• Taking medication on time and in the correct dosage: Strict adherence to the ARV regimen prescribed by a doctor is crucial for the treatment to be maximally effective.
• Avoiding unilateral discontinuation: Stopping medication on one’s own can lead to drug resistance, reduce treatment effectiveness, and complicate future therapy.

Overall health status

• Co-infections: People living with HIV are at a higher risk of contracting co-infections such as hepatitis B and C, tuberculosis, and other sexually transmitted diseases. The proper management of these conditions is critical.
• Chronic conditions: Chronic illnesses such as cardiovascular disease, diabetes, and cancer can also impact life expectancy.
• Comprehensive health care: Regular health check-ups, complete immunization, and proactive management of other health issues are essential.

Healthy lifestyle

• Balanced diet: A nutritious diet rich in vegetables and fruits, while limiting processed foods, sweets, and saturated fats, is important.
• Regular exercise: Consistent physical activity helps improve cardiovascular health, boosts the immune system, and enhances mental well-being.
• Avoiding smoking and limiting alcohol: Smoking and excessive alcohol consumption can weaken the immune system and increase the risk of other illnesses.
• Maintaining a positive outlook: An optimistic mindset helps individuals better cope with the disease and improve their quality of life.

Common misconceptions about the life expectancy of people with HIV

Despite the progress in HIV/AIDS treatment, several misconceptions persist regarding the life expectancy of people living with HIV:

• Misconception 1: HIV remains a “Death Sentence” even with ARV.
  Fact: This is entirely incorrect. ARV treatment has transformed HIV from a rapidly fatal disease into a manageable chronic condition. Individuals on ARV can live long and healthy lives.
• Misconception 2: People with HIV can’t live long and healthy lives.
  Fact: Many people living with HIV around the world lead active, healthy lives and enjoy a life expectancy nearly equivalent to that of the general population, thanks to ARV treatment. They continue to work, study, build families, and contribute to society.
• Misconception 3: ARV treatment is very complex and has many side effects.
  Fact: Modern ARV drugs have been significantly improved, with simplified treatment regimens (often just 1-2 pills per day) and minimal side effects, which are usually mild and manageable.

Life insurance for people living with HIV/AIDS

Is life insurance available for people living with HIV/AIDS?

The good news is, YES – people living with HIV/AIDS in the United States can access life insurance programs. Although not all insurance companies offer coverage, more and more companies are recognizing that with ARV treatment, people with HIV can live healthy, long lives, and they have broadened their policies to include this group.

Key considerations when seeking life insurance

When searching for life insurance, individuals with HIV/AIDS should note the following:

• Not every company offers coverage: Proactively research and contact “HIV-friendly” insurance companies instead of assuming you are automatically disqualified.
• Detailed health information required: Be prepared to provide comprehensive and honest health information as required by the insurance company. This includes:
  • The time of HIV diagnosis.
  • The current ARV treatment regimen and adherence history.
  • The most recent viral load and CD4 test results.
  • Medical history and any co-infections (if applicable).
  • Overall current health status.
• Higher premiums: Due to the perceived higher risk, insurance premiums for people with HIV/AIDS are generally higher than for those without HIV. However, the exact premium depends on individual health conditions and the policy of the company.
• Waiting periods: Some policies may have a waiting period before full benefits become effective, especially for death benefits related to AIDS.
• Exclusion clauses: Carefully read the policy to understand the exclusion clauses – i.e., the circumstances under which coverage will not apply.

Remember, having life insurance is a way to provide financial protection for yourself and your family, even when living with HIV.

FAQs

1. When should a person with HIV stop taking ARV drugs?

ARV treatment is lifelong. Stopping ARV drugs can lead to a resurgence of HIV, increased viral load, weakening of the immune system, and a higher risk of opportunistic infections. Continuous adherence to ARV treatment is key to controlling HIV and maintaining long-term health. There is no official guideline permitting the discontinuation of ARV treatment unless under special circumstances in tightly controlled clinical trials.

2. Is it possible to completely cure HIV?

Currently, HIV cannot be completely cured. Although ARV treatment is extremely effective in controlling the virus and enabling people living with HIV to lead healthy lives, no method has yet been found to eliminate HIV from the body. HIV can hide in cellular “reservoirs” that current ARV drugs cannot reach. However, scientists are actively researching new treatments – including gene therapy and vaccines – hoping to find a cure in the future. The current treatment goal is to control the virus to an “undetectable” level (Undetectable = Untransmittable, or U=U), allowing individuals to live healthily and prevent transmission.

3. How much does HIV treatment cost?

The cost of HIV treatment varies greatly depending on the type of ARV drugs, insurance coverage, and available financial assistance programs.

• Health insurance: Most people with either private or public insurance (such as Medicaid or Medicare) have a large portion of their ARV costs covered. Out-of-pocket expenses depend on the specifics of the insurance plan (e.g., deductibles, copays, and coinsurance).
• Assistance programs: There are several financial assistance programs available to help low-income or uninsured individuals access ARV treatment, including:
  • The Ryan White HIV/AIDS program is a federal program that provides care services and medications for low-income individuals with HIV.
  • Patient Assistance Programs (PAPs) are offered by many pharmaceutical companies that manufacture ARV drugs.
  • State Pharmaceutical Assistance Programs (SPAPs) that may help cover ARV drug costs at the state level.

To determine specific costs and financial assistance options, individuals with HIV should:

• Contact their health insurance provider.
• Learn about local Ryan White HIV/AIDS Program offerings.
• Check the Patient Assistance Programs on the websites of ARV drug manufacturers.
• Consult with HIV/AIDS support organizations for guidance.

4. What happens if I miss a day’s dose of ARV?

Missing one day of ARV medication may pose certain risks, but the severity depends on several factors, including the specific ARV drug, the duration of treatment, and your overall health.

• Increased viral load risk: Missing a dose can lower the drug concentration in your blood, potentially allowing HIV to replicate.
• Risk of drug resistance: Frequently missing doses may increase the chance that HIV develops resistance, reducing the effectiveness of the current treatment regimen over time.

Advice:

• If you miss a dose, take it as soon as you remember – unless it is nearly time for your next dose. In that case, skip the missed dose and resume your regular schedule. Do not double up on doses to make up for the missed one.
• Establish a routine for taking your medication (e.g., set an alarm, associate it with a daily activity).
• If you consistently miss doses, consult your doctor or pharmacist for strategies such as using a pill organizer, medication reminder apps, or switching to a simpler treatment regimen.

5. Can I take other medications alongside ARV?

Yes, you can take other medications while on ARV treatment, but caution is needed. Always inform your doctor about all medications, supplements, and herbal products you are taking. Drug interactions are an important consideration in HIV treatment since ARV drugs can interact with various medications – prescription, over-the-counter, or herbal – which may alter drug levels in the body, reducing treatment efficacy, increasing side effects, or leading to serious health issues. Some interactions can be dangerous and must be avoided.

Advice:

• Always notify your doctor and pharmacist of every medication, supplement, or herb you are using (or plan to use) before starting or changing any medication, including ARV.
• Pharmacists can check for potential interactions and advise you on safe medication practices.
• Do not combine or discontinue any medications on your own without guidance from your healthcare provider.

6. Should ARV be taken before or after meals?

The timing for taking ARV medication varies depending on the specific drug. Some ARV medications need to be taken with food to enhance absorption, while others can be taken before or after meals without affecting their efficacy; a few even need to be taken on an empty stomach.

Advice:

• Always follow your doctor’s and pharmacist’s instructions regarding when to take your ARV medication.
• Carefully read the medication guide that comes with your ARV drugs for detailed usage information, including timing.
• If you are uncertain, consult your doctor or pharmacist.
  Taking your medication at the correct time as instructed is an important part of adhering to ARV treatment.

7. Where can I purchase ARV medication?

ARV drugs are dispensed only with a doctor’s prescription and can be obtained from the following sources:

• Hospital or HIV clinic pharmacies: Many hospitals and specialized HIV/AIDS clinics have in-house pharmacies where patients can purchase or receive ARV medications with a prescription.
• Retail pharmacies: Some large retail pharmacies (e.g., Walgreens, CVS, Rite Aid) may also offer ARV medications, especially those affiliated with insurance or pharmaceutical assistance programs.
• Home delivery services: Certain insurance plans or pharmacies provide home delivery services for ARV medications.

Requirements for purchasing ARV:

• A valid prescription from an HIV specialist.
• Presenting the prescription at the designated pharmacy (or a pharmacy approved by your provider).
• Show your health insurance card (if applicable) and any necessary identification documents.

8. What types of ARV drugs are there?

There are various groups of ARV drugs used to treat HIV, including:

• Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs): e.g., tenofovir, emtricitabine, lamivudine, abacavir, zidovudine.
• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): e.g., efavirenz, nevirapine, etravirine, rilpivirine, doravirine.
• Protease Inhibitors (PIs): e.g., darunavir, ritonavir, lopinavir, atazanavir.
• Integrase Strand Transfer Inhibitors (INSTIs): e.g., dolutegravir, raltegravir, elvitegravir, bictegravir, cabotegravir.
• Entry Inhibitors: e.g., enfuvirtide, maraviroc, fostemsavir, ibalizumab.

Typically, ARV treatment regimens combine 2 – 3 drugs from different classes to achieve optimal results. The doctor determines the specific ARV regimen based on the patient’s health condition, viral load, CD4 count, co-infections, and other personal factors. Current regimens are generally simple, easy to take (often only 1 – 2 pills per day), and have fewer side effects than previous treatments.

Conclusion

ARV treatment has revolutionized the management of HIV/AIDS. With ARV, people living with HIV can not only extend their life expectancy but also lead healthy, fulfilling lives with a bright future. Remember: HIV is no longer a “death sentence.” Early testing and prompt treatment are the keys to protecting your health and prolonging life.

If you have any concerns about HIV/AIDS, consult a healthcare provider for timely advice, testing, and treatment. Don’t let HIV prevent you from living a full life – managing HIV is not the end but the beginning of a new chapter!