People infected with HIV through sex have no increased death rate within five years if they get the best treatment. That's the conclusion of a British study of 16,000 people. But the death rate within 10 years was a bit higher for some age groups. Death rates also were higher, even within five years, for injection drug users, men, and people who were older when infected. HIV stands for human immunodeficiency virus. This virus causes AIDS. The study appeared in the Journal of the American Medical Association.

What Is the Doctor's Reaction?

Human immunodeficiency virus (HIV) infection continues to be an important cause of suffering and death worldwide. Yet, it's amazing how far treatment has come during the last 25 years.

HIV causes acquired immunodeficiency syndrome (AIDS). When I was an intern in 1983, HIV infection was a new illness. Then, it was nearly always fatal in a short period of time.

Most of the early cases were homosexual men who had been previously healthy. They would be admitted to the hospital with pneumonia, weight loss, skin cancers (called Kaposi's sarcoma) and unusual infections. Within months of first falling ill, many of these men died. On a typical day, there were several such patients on a medical floor of the hospital.

Things are quite different now. HIV/AIDS is still a serious problem worldwide. But those who are taking effective treatment often live healthy, productive lives. It's common to find no patients with HIV on our hospital's wards.

The treatment is called highly active anti-retroviral therapy, or HAART. In places where HAART is available, the medical care of people with HIV has shifted largely to the outpatient setting.

A new study from London shows just how far the treatment of HIV has come. It included more than 16,000 people followed for about 6 years. Researchers compared death rates of those infected with HIV with death rates of the general population. They made a remarkable observation: Among those diagnosed in the last 10 years, there was no increased risk of death in the first 5 years of infection.

Over 10 years of infection, however, an increased death rate was seen. For example, after 10 years of infection, the death rate was 4.8% higher among people ages 15 to 24. It was 4.3% higher among those who were at least 45 years old.

Since the development of HAART, excess deaths related to HIV infection have declined by 94%.

In this study, people who had higher death rates related to HIV infection were more likely to be:

  • Older at the time HIV infection was first diagnosed

  • Users of injection drugs

  • Males

The finding that people living with HIV infection are living longer does not surprise me. But the amount of improvement in the last two decades is surprising. There are few examples of such dramatic turnarounds in medicine. The term "medical breakthrough" is sometimes used loosely in medical news reports. HAART therapy truly deserves this description.