Question
Do fast progressors have a shorter life expectancy?
13 May 2008. Related: All topics, Living with HIV long-term, Starting treatment.
Some people they can go nearly 20 years with HIV and not need treatment, whilst others start treatment within a year of being infected. For these people who start treatment early, who are fast progressors, is their life expectancy shorter?
Answer
You are right that there is a very wide range of responses to HIV infection.
Although most people can go 5-6 years before they need treatment, a few people progress more quickly (fast progressors) and a few people can go for much longer (slow progressors).
Without treatment, things are worse if you progress quickly.
However, there is no difference between how well treatment works, or how long it works for. With treatment, fast progressors should have the same life expectancy as slow progressors.
Life expectancy may even be slightly better for people who start early treatment. Some recent studies are showing that being on treatment with undetectable viral load can be protective of serious illness, compared to having detectable viral load, even with high CD4 counts.
The comment about using treatment for 10, 20 or 30 years is really to give you an idea of long-term treatment. None of the current treatment have been used in combination for this long, and in reality, newer drugs are also likely to be available to replace our current drugs.
If you are adherent and use treatment carefully, and get your viral load to undetectable (less than 50 copies/mL) then resistance is very unlikely.
Hi Simon
Thanks for your response
You say that someone who starts treatment earlier (e.g. within a year of infection) should have the same life expectancy as someone who has to start later.
But doesn’t it make a difference that some people can go 10 years without treatment and then have the benefit of combination therapy (another 20-30 years)? Where as people who start treatment earlier do not have the benefit of being without treatment for 10 years and they have to go straight on to treatment and risk resistance early on in their disease.
I wish I could put my mind at rest.