So doctor, how long have I got?
I bet most people with HIV ask their doctor how long they can expect to live after they receive their diagnosis. This edition of HIV Weekly reports a study that estimates that HIV treatment will work for a quarter of a century. I had really mixed feelings about this estimate. On the one hand it’s good news, and significantly better than the ten years or so prognosis from diagnosis that faced most people with HIV in the pre-treatment era.
But then I can’t help feeling disappointed that it’s not longer, and even felt a pang of fear that HIV may yet mean a premature death. I’ve become used to thinking that my HIV treatment will work indefinitely, after all, it’s almost nine years since I started my first combination (which I’m still taking) and I have an undetectable viral load and a CD4 cell count well over 1,000. Let’s hope it stays that way.
I know that other people haven’t been as fortunate as this, but thanks to recent advances in HIV treatment, doctors now think that even people who have taken lots of HIV drugs before should be able to get an undetectable viral load with the right combination of drugs.
And let’s not forget that researchers are still looking at new ways of treating HIV and that this research will undoubtedly produce more powerful, better-tolerated drugs than those currently available.
So all in all, I still think that many, if not most people who receive good quality HIV care in this country can expect it to work for a lot longer than 25 years. I’d better start paying more into my pension…
What’s the life expectancy with HIV treatment?
It’s perfectly natural to want to know how long you’re going to live after you’re diagnosed with a serious, life-threatening infection like HIV. The technical term that doctors often use is prognosis, and before effective anti-HIV therapy became available in the late 1990s, it was thought that the life-expectancy of somebody newly infected with HIV was between eight and 13 years.
But thanks to potent combinations of anti-HIV drugs, many people with HIV are now living much longer and healthier lives, and many doctors are now optimistic that most people who are treated with HIV therapy (and who take it properly and don’t find the side-effects too intolerable) will live a more or less normal lifespan.
They assumed that HIV treatment would be used according to US treatment guidelines (these are different in a number of important ways to UK treatment guidelines. Most notably, they recommend that HIV treatment should be started when a person’s CD4 cell count is 350 – that’s much higher than the 200 recommended by the UK guidelines). They assumed that people would then take three different HIV treatment combinations before having to take a ‘salvage’ regimen including T-20. They calculated HIV treatment would work for just under 25 years and cost a total of approximately £200,000.
But these calculations were conducted before the even more powerful protease inhibitors, tipranavir (Aptivus) and darunavir (Prezista), became available for people who had taken a lot of HIV treatment before, and which could mean an even longer life expectancy.
Nor will all doctors agree with the assumptions of the article that the first HIV treatment combination will inevitably fail. There is very good evidence that if viral load is kept to undetectable levels an HIV treatment combination will work for an indefinite period.
And it is worth remembering that as well as the 20-plus drugs currently available for HIV treatment, researchers are trying to develop new ways of attacking the virus. Studies were recently published showing that radioimmunotherapy was able to eliminate HIV-infected cells from mice, and a new genetic treatment for HIV has promise.
HIV treatment and the liver
The liver is the body’s largest internal organ. It is particularly important that people with HIV have a healthy liver as the liver processes medicines used to treat HIV and other infections.
Unfortunately, many people with HIV are infected with hepatitis B and/or hepatitis C, viruses that can cause serious or even fatal damage to the liver.
Lifestyle factors, such as drinking too much alcohol, or using certain recreational drugs, can also cause liver damage.
It is also known that some medicines, including drugs used to treat HIV, can cause liver damage.
They found that having poor liver function before taking HIV treatment was a risk factor. Certain HIV drugs were also associated with an increased risk of liver problems, most notably ddI (Videx) and nevirapine (Viramune). Using drugs to treat other illnesses and infections (such as some antifungal drugs, some antibiotics, anti-TB drugs and anticonvulsants) also caused liver problems. Unsurprisingly, both hepatitis B and hepatitis C were also associated with liver problems.
HIV drugs and pregnancy
It is possible for an HIV-positive mother to have an HIV-negative baby.
One of the key ways by which mother-to-child transmission of HIV is prevented is by the use of anti-HIV drugs during pregnancy.
The anti-HIV drug efavirenz (Sustiva) should not be used during pregnancy because a small number of mothers who took it whilst pregnant had babies with severe birth-defects. Some researchers have also expressed concern that the use of protease inhibitors during pregnancy increase the risk of having a premature or low birth weight baby. But the evidence here is controversial, and many doctors, particularly in the UK and Europe, aren’t convinced that this is the case.
The researcher also found that the babies of women who received HIV drugs were only born a week or so before those of women who did not receive HIV drugs, and that babies exposed to HIV drugs in the womb weighed only a few hundred grams less than babies of HIV-negative mothers.
But the researchers did find that the infants of mothers who took methadone or a methadone substitute had poor mental development.