What Is the New Lifespan for HIVers?

Walter Armstrong

If you were to test positive for HIV today, you can expect to live for at least another 24 years, according to a new study in "Medical Care," a journal published by the American Public Health Association. Of course, you'll have to take HIV drugs every day—at a total cost of $400,000, and throw in another $200,000 for doctor visits and other health care.

These new figures are a national average based on 7,000 medical records culled from HIV specialists and calculated by Dr. Bruce Schackman of the Weill Medical College of Cornell University in New York.

Schackman also reported that the average HIVer is infected at age 31, starts taking HIV meds eight years later, and dies at 63.

These statistics represent, by almost any measure, remarkable medical progress since the epidemic first devastated gay communities nationwide in the 1980s. Even in 1993, the average life expectancy for a healthy HIV positive person was fewer than seven years.

But with the advent of new classes of drugs and triple-combo therapies in 1996, what once was a fatal disease has been transformed into a chronic disease—or, say, a fatal disease that takes 24 years and $600,000 worth of health care to kill you.

In fact, Schackman discovered that many patients died not of the opportunistic infections once associated with AIDS, but of heart disease, cancer, and other illnesses more common to aging itself. It's widely suspected, however, that HIV treatment may be partly responsible for the development of these serious health problems. The drugs are a powerful form of chemotherapy, and no one really knows what risks daily dosing over decades can do to you. There's no guarantee that a patient starting on a triple-drug HIV cocktail today will be able to stay healthy and keep taking them until 2030.

Still, it's reasonable to expect that with the development of new classes of HIV meds, the living-with-HIV trend will continue to be up. While this is good news for anyone with HIV, progress does have its downside. The longer you live, the higher your health-care costs. And with many Americans living with HIV already dependent on special government benefits and other assistance to fund their pricey treatment, the bigger the HIV price tag for the American people will grow.

In this context, the study raises more questions than it answers. Will we as a nation remain as "generous" to people with HIV, whose annual drug cocktail rings in at $25,000 per, in five years, or fifteen as we are today?

Even today, as Shackman has been quick to emphasize in the extensive coverage his study has received, HIV funding is not keeping up with either inflation or the rising number of new diagnoses. "If funding continues to be flat, a lot of people are not going to be effectively treated and they're more likely to infect other people," he warned.

This threat of untreated HIVers infecting others may backfire, however, by demonizing them. Still, it may be one of the few cards left for HIV activists to play. After all, most government freebies were won at a time when the disease was viewed as a crisis. And what about caps on private insurance and Medicare for HIV-positive seniors? What happens now that the disease is seen as an avoidable infection—and one that only reckless, irresponsible people get?

And what about prevention? If HIV no longer strikes fear into your soul, what will motivate you to keep using condoms and practicing safe sex?

That may be the most important question the people who are in charge of HIV-prevention campaigns can ask themselves before coming up with their next slogan.