Q and A


I’m on ART but worry about inflammation and long-term health…

I am 36 and was diagnosed in June 2017. My CD4 was 396 and I have been taking treatment since October. I am now nearly undetectable, have recently quit smoking and drinking, and go to the gym 4 times a week.

However, I am still worried that just having the virus itself will reduce my life expectancy. I’m particularly anxious about the thought of getting inflammation of the heart (causing cardiovascular disease) and neurocognitive disorder, which I have read are more common in HIV positive people.



Thanks for your question.

It is great that you are on ART, are good at taking meds, and have also made lots of good lifestyle changes.

Doing all these things are the best way of staying healthy and having good quality of life for a long time. They mean that you are likely to live as long as you would have before finding out you were positive. Actually, because of the lifestyle changes, and greater interaction with seeing a doctor, your life expectancy might even be longer.

Worrying about long-term HIV though is still very common. It is especially easy when news stories about HIV emphasis higher risks of various complications. In general though, these higher risks come when HIV positive people as a group are compared to the general population.

This doesn’t mean that individuals we are all at higher risk of worrying things. It usually means that as a group HIV positive people have higher risks because of different life experiences. For example, a higher percentage of HIV positive people smoke, drink, take drugs, have more sex etc compared to the general population etc. When HIV positive people are compared to a group of HIV negative people where these risks are well matched, many of the differences in life expectancy disappear.

Also, in these comparisons, the HIV positive group includes some people who’s HIV history increases various risks, for example if their CD4 count ever went very low or if they waited many years before starting treatment.

The research into immune inflammation, cardiovascular disease and neurocognitive disorder is really important. Some signals of higher inflammation continue even on ART. But the absolute risks for these events are generally still very low. Being on treatment (ART) means there is so little HIV in your body that it is unlikely to cause problems for most people, even over decades.

This makes it important to look after your health in the ways you are already doing. Keeping mentally and physically active, eating a good nutritious diet, getting good sleep and moderation for less-healthy things in life is all good.

Having fun and relaxing is just as important – and is keeping aware of your health and HIV research. Sometimes though HIV news reports focus on negative news, without the context that this is likely to have small changes on someone’s absolute risk. This makes it easy to worry.

You are lucky to still be young and active and you have made changes to stay healthy that will help. Enjoying life now is also important.


  1. Kirk

    I couldn’t hold my cry when googled and saw this post among first, because I’m in almost the same situation from recently, with exactly the same question regarding immune inflammation, and I also trying to figure out about faster aging reported for hiv positive people, though I believe this later is more related to lifestyle and stress.
    Thank you a million for the post and the answers. Also, recent studies show immune inflammation in general population, e.g. obese people, people in big cities exposed to air pollution, or stressed people, and such inflammation is measured from very recently and scientists can’t really agree how to actually measure it, and what does it mean on short and long term. As mentioned, we must read and interpret news and info with great caution, because much of living with hiv is wrapped with mind-game, so to speak.

  2. Simon Collins

    Thanks Andrew, we try to keep a balance when interpreting HIV news. Effective ART reduces HIV to such tiny levels that if big effects were going to be seen, we would have seen this in the last 20 years of modern treatment.

  3. Andrew

    Thank you Simon for your response. Your words have helped me massively. For months I have been asking doctors and nurses the same types of questions and only ever received vague and equivocal answers from them. Thank you so much.


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