Is it Time to Redefine HIV?

HIV, when properly treated, isn't the killer it once was. Modern medicine has stretched the lifespan of HIV-positive patients to near-normal levels. The real pain is the psychological damage that comes from an HIV diagnosis. 

Doctors around the world are acknowledging the current state of HIV. “As a doctor, I'd rather have HIV than diabetes,” British doctor Max Pemberton wrote in 2014. It was a strange statement, coming from a doctor and in reference to one of the worst epidemics the world has seen since the Black Death. In the '80s and '90s, an HIV-positive diagnosis, of course, meant certain death. But Dr. Pemberton is right—the worst thing about HIV is the stigma—but its current killing power is nowhere near what it used to be.

When someone says “I'm diabetic,” it doesn't generate the same shock as disclosing an HIV-positive status. But the unwarranted reactions to an HIV diagnosis shouldn't be the norm, especially when comparing HIV to the dangers associated with other illnesses. We shouldn't downplay the severity of HIV, but on the other hand, we shouldn't ignore the progress of medicine.

On June 1, Antigua's Minister of Health, Molwyn Joseph, called for an end to the “psychological death” that's associated with an HIV diagnosis. Antigua's health officials have improved access to HIV medicine. The island now has 17 HIV testing centers to help battle the spread of HIV.

According to the World Health Organization, there are at least  five diseases that are more deadly than HIV. HIV is pushed to number six of the world's deadliest diseases thanks to epidemic levels of the disease in sub-Saharan Africa. Ischaemic heart disease is the world's number one killer, with cardiovascular disease, lower respiratory infections, chronic obstructive pulmonary disease and diarrheal diseases all ranking more deadly than HIV. Diabetes mellitus is wiggling its way up there, coming in at number nine.

Prior to effective medicine—which came in the form of antiretroviral combination therapy in 1997—there was no way to effectively beat the HIV virus. Reverse transcriptase inhibitors changed the game, and controlling HIV replication suddenly became a realistic option for those who had no other options.

From 1988 to 1995, HIV's mortality rate was a grim 78 percent. That meant that over three-quarters of those infected with HIV would surely die. But by the time the period spanning 2005 to 2010 arrived, that mortality rate had plummeted to 15 percent. The post-ARV era marked a second chance for those who were diagnosed as HIV-positive.

Let's compare that to the diabetes mortality rate. A study published in The New England Journal of Medicine found a 17.7 percent mortality rate among patients with type 2 diabetes in a non-controlled group after only 4.6 years of follow-up. In the controlled group, results were better, however 14.5% of participants in the control group died after 4.8 years of follow-up. Judging by these numbers, HIV in America is no more deadly than type 2 diabetes.

A study published in the Journal of Acquired Immune Deficiency Syndromes found that HIV-positive people can live a near-normal lifespan, however an 8-13 year gap in life expectancy remains. The life expectancy of HIV-positive people was analyzed and reported at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI 2016). In the Kaiser Permanente health insurance system, the life expectancy of HIV-positive patients is only two years less than the general population. However, evidence suggest that HIV-positive patients lifespan can shorten, especially when smoking, drugs and other risk factors are taken into consideration.

It's time that we redefine HIV as a the equivalent to a chronic disease. The U.S. National Center for Health Statistics defines a chronic disease as one that persists for three months or more. Diseases like diabetes or cardiovascular disease are considered chronic diseases and require constant maintenance. Prevention is key, but early detection of these diseases can control the diseases enough to live a near-normal life expectancy.

It's time to stop classifying HIV as an untreatable epidemic. HIV is not curable, but it's possible to control the virus with modern medicine. Sub-Saharan Africa accounts for three-quarters of the 25 million people that have died from AIDS since the epidemic first emerged 25 years ago. But for those who have access to proper medicine, a long life is now an option. HIV is a horrible disease, but it doesn't have to stay that way.