The continuous development of new and improved medical treatment both for HIV and the illnesses associated with it,  has led to major changes in the pattern of HIV disease progression which people in the UK and similar countries can expect to experience.

First of all, doctors have become very skilled at treating some AIDS-defining illnesses. For example, the AIDS-defining  pneumonia PCP was often fatal in the very early days of the HIV epidemic. Now, doctors are able to treat it and people who have had it go on to live healthy lives for many years afterwards.

What’s more, doctors know how to prevent many infections from occurring in the first place. Once your immune system becomes damaged to such an extent that you are vulnerable to certain infections, it is possible to take medicines to prevent these developing. This is called prophylaxis. It’s considered in more detail in the section Symptoms and illnesses.

However, the biggest improvement of all came in the mid-1990s, when effective treatment that targets HIV itself became available. This antiretroviral treatment have led to very substantial reductions in the numbers of people dying of HIV or becoming ill because of HIV in the UK and similar countries. Use of antiretroviral drugs has been shown to prevent peoples' immune systems from becoming weakened by HIV. What’s more, antiretroviral therapy has also been shown to work for many people with advanced HIV disease. It's also worth noting that there have been further significant improvements in antiretroviral treatment since the mid-1990s. Newer anti-HIV drugs are more powerful, cause fewer side-effects and are easier to take. Many more promising anti-HIV drugs are in development.

Treatments for HIV are considered in a lot more detail in the section Anti-HIV treatment.

Prognosis

The prognosis for people with HIV has changed dramatically since the first cases of AIDS were diagnosed in the early 1980s. In those early days, it was thought that most people would die within a few months of first being diagnosed with the condition. This changed, partly because it was recognised that HIV was the cause of AIDS and that it took many years to gradually destroy the immune system, and partly because doctors gradually learnt more about recognising and treating infections and cancers commonly seen in people with HIV. By the mid-1990s (before the introduction of effective anti-HIV treatment), it was thought that in rich countries such as the UK it would take between eight and fifteen years (on average) after infection with the virus for HIV to cause life-threatening illness or death.

Many HIV doctors now believe that provided a person with HIV receives effective anti-HIV treatment before their immune system has been severely damaged by the virus, and if they take their drugs properly and can tolerate them, they could live a more or less normal life span.

The use of Highly Active Antiretroviral Therapy (HAART; combinations of drugs which slow down the rate at which HIV is able to reproduce) from the mid-1990s onwards has led to dramatic improvements in the prognosis for people with HIV. For instance, AIDS deaths in the UK have fallen from a peak of over 1,500 in 1994 to approximately 400 a year at present. The AIDS deaths which still occur in this country often involve people who are diagnosed with HIV late in the disease process, when their immune system is already severely damaged.

Research into the prognosis of people starting HIV treatment indicates that the risk of becoming very ill or dying because of HIV within the next three years is linked to five key factors: having a CD4 count below 200 or a viral load above 100,000 at the time of starting treatment; being aged over 50; being an injecting drug user; or having had a prior AIDS-defining illness.

In the UK it is recommended that anti-HIV treatment is started before your CD4 count falls below 200, which is an indication that HIV has damaged your immune system to such an extent that you are vulnerable to serious illness. It is also strongly recommended that you start anti-HIV drugs if you become ill because of HIV. Starting treatment in these circumstances has been shown to improve prognosis compared to delaying treatment until later.

You can find out more about when to start HIV treatments in the section Anti-HIV treatment.

Some non-AIDS-related illnesses are seen relatively frequently in people with HIV, despite the effectiveness of HAART. These include liver disease caused by hepatitis viruses B or C; certain cancers, such as lung cancer, testicular cancer and anal cancer; and mental illnesses such as depression. In addition, HIV treatments themselves can cause long-term side-effects which can seriously affect health or quality of life.

There’s more information on hepatitis B and C in the section on Symptoms and illnesses, and depression is considered in a lot more detail in the section on Mental health. The section Side-effects provides a lot more information about these.

Obviously, there are many other causes of ill health apart from HIV, and so more general health advice (such as stopping smoking, taking regular exercise, eating a balanced diet) is also relevant to people with HIV. To find out more about these issues, read the section Daily health issues.