Life expectancy for people living with HIV

HIV-positive people are living increasingly long lives. Many people living with HIV can expect to live as long as their peers who do not have HIV.

Studies show that a person living with HIV has a similar life expectancy to an HIV-negative person – providing they are diagnosed in good time, have good access to medical care, and are able to adhere to their HIV treatment.

A number of factors can affect the life expectancy of people living with HIV. There are differences in outcomes between different people, depending on these and other factors.

• Access to effective HIV treatment and high quality medical care.
• Having a high CD4 count and undetectable viral load. People with a high CD4 count and undetectable viral load have much higher life expectancies than those with low CD4 counts and high viral loads. Your current CD4 count and viral load have a much greater influence on your life expectancy than if you had a low CD4 count and high viral load in the past, so finding the right treatment for you and staying on it can improve your life expectancy over time.
• Having serious HIV-related illnesses. This may have occurred before HIV was diagnosed and/or before HIV treatment was begun. These illnesses have a negative impact on life expectancy.
• Other health conditions, such as heart disease, liver disease and cancer. They are more likely to be the cause of death than HIV.
• Injecting drug use – life expectancy is shorter for people with HIV who inject drugs, due to drug overdoses and bacterial infections.

It’s also important to consider things that affect everyone’s life expectancy, whether or not they have HIV.

• Social and economic circumstances – there are important differences in life expectancy according to where you grow up, your income, education, social class and so on.
• Gender – women usually live longer than men.
• Genetics – you may be more likely to develop certain conditions if you have a family history of them.
• Mental and emotional wellbeing – higher levels of stress are associated with reduced life expectancy.
• Lifestyle – life expectancy is longer for people who have a balanced diet, are physically active, maintain a healthy weight, avoid excess alcohol or drug use, and remain socially connected. Avoiding smoking is particularly important for life expectancy.

How is life expectancy calculated?

Life expectancy is the average number of years that a person can expect to live.

More precisely, it is the average number of years an individual of a given age is expected to live if current mortality rates continue to apply. It is an estimate that is calculated by looking at the current situation of a group of people and projecting that into the future.

However, HIV is a relatively new disease and HIV treatment is a rapidly changing area of medicine. It is therefore hard to know whether our current experience will be an accurate guide to the future.

At the moment, there are large numbers of people living with HIV in their twenties, thirties, forties, fifties and sixties. Current death rates are very low, resulting in encouraging figures for future life expectancy. But we have very little experience of people living with HIV in their seventies or eighties, so we know less about the impact HIV may have later in life.

Also, health care for people with HIV is likely to get better in the future. People living with HIV will benefit from improved anti-HIV medications that have fewer side effects, are easier to take and are more effective in suppressing HIV. Doctors’ understanding of how best to prevent and treat heart disease, diabetes, cancers, and other conditions in people with HIV is improving. This could mean that people actually live longer than our current estimates suggest.

When reading about life expectancy, it’s important to bear in mind that researchers do not always have access to all the information that is relevant. For example, they don’t usually know how physically active people were, whether they smoked, or whether they used recreational drugs.

Although these factors have a great influence on health, the data aren’t available to produce precise life expectancy estimates according to each one. So, there are estimates according to people’s age at HIV diagnosis and CD4 count, but we don’t have estimates that take lifestyle and social factors into account as well.

It’s important to remember that figures for life expectancy are averages. The unique combination of circumstances in each person’s life – including health, lifestyle and social conditions – will influence the actual number of years a person lives. It may be more or less than the average.

What is the life expectancy for people living with HIV in high-income countries?

A study published in 2023 looked at the outcomes of over 200,000 adults living in North America and Europe who started HIV treatment between 1996 and 2019. The analysis was limited to those who were aged 16 or over when starting treatment, therefore mostly excluding those who acquired HIV as children, but otherwise included a wide range of people living with HIV. The study was the first to compare life expectancies of those who have been on antiretroviral therapy (ART) for many years to those who started ART more recently.

The key finding was that that for people on treatment and with high CD4 cell counts, life expectancy was only a few years lower than the general population, regardless of when they had started treatment. People who started treatment after 2015 have a slightly higher life expectancy than those who started ART before 2015. However, CD4 cell count has the strongest influence on life expectancy.

The study first looked at people who had started ART between 1996 and 2014 and were still alive and on treatment in 2015, when follow-up data began to be collected. For this group, the average life expectancy for those currently aged 40 was 76 years for women and 75 for men, compared to 86 and 81 in the general population, respectively. However, there was a considerable range in estimates depending on the factors outlined above.

For example, a 40-year-old woman who started treatment before 2015 with a CD4 count between 200 and 349 at the start of follow-up could expect to live to 74, and a man in the same situation could expect to live until 72. If they had a CD4 count above 500 at the start of follow-up they could expect to live to 80 and 78 years, respectively. If they also had a suppressed viral load, no AIDS diagnosis at the start of follow-up, and didn’t acquire HIV through injecting drug use, their life expectancy would increase to 82 and 79 years, respectively.

Next, the study looked at people who started ART between 2015 and 2019 and subsequently survived for at least a year, when their follow-up data began to be collected. The 2015 cut-off was chosen as this was when treatment guidelines changed to recommend treatment for all people diagnosed with HIV, no matter what their CD4 count was.

For this group, the average life expectancy for those currently aged 40 was 79 years for women and 77 for men. If they had a CD4 count between 200 and 349, their life expectancy was similar to the average, calculated as 78 and 77, respectively. Whereas if their CD4 count was above 500, their life expectancy increased to 82 and 79 years, respectively.

If, in addition to a CD4 count above 500, they had a suppressed viral load, no AIDS diagnosis at the start of follow-up, and didn’t acquire HIV through injecting drug use, a 40-year-old woman could expect to live to 83 and a 40-year-old man could expect to live to 80.

These days in the UK, very few people die as a direct result of HIV. When deaths do occur, they usually happen in the first year after diagnosis and involve people who were diagnosed with HIV very late, when they were already very ill because of HIV. In many of these cases, the person did not attend an HIV clinic or did not take HIV treatment, or only did so irregularly.

Years in good health

Although people living with HIV now have similar life expectancies to HIV-negative people, studies show that they may spend fewer of their years in good health. People living with HIV appear to have higher rates of illnesses typically associated with ageing, such as heart disease, diabetes, osteoporosis and kidney disease. One US study found that on average, people living with HIV are likely to develop major illnesses 16 years earlier than those who are not living with HIV. As with life expectancy, this is likely due to a combination of factors including HIV and its treatment, socio-economic circumstances, and lifestyle. For more information, visit our pages on health problems and ageing.

Summing up

With the right treatment and care, most people living with HIV in the UK will have a more or less normal lifespan. Very few people in the UK fall ill or die as a direct result of HIV anymore.

In fact, the most important causes of illness and death in people living with HIV are now quite similar to those in the general population. They include heart disease, kidney disease, liver disease, diabetes, depression and cancers. People living with HIV may develop these conditions earlier than those who do not have HIV.

A wide range of factors affect your risk of developing these conditions. Some of them are things you can’t change, like your age, a family history of certain diseases, or having HIV.

Other risk factors are within your power to change. You can increase your life expectancy by not smoking, being physically active, having a balanced diet, maintaining a healthy weight, avoiding excess alcohol or drug use, and remaining socially connected.