Live Long and Prosper

R.J. Hadley was leery as experts--including his own health care providers--grew more optimistic over the years that antiretroviral treatment could prevent HIV from cutting his life short. 'I was always waiting for the other shoe to drop,' explains the 45-year-old Chicago resident, who has lived with HIV for two decades, 'especially since there wasn't any proof to back up what they believed was happening.' Not anymore, though. For the first time in the history of the AIDS pandemic, researchers have hard evidence to show that successful long-term treatment can give some HIV-positive adults exactly the same life spans as their negative peers. 'It's terrific to have a study that says, 'Yes, it's true. It's real!'_' says Shawn Decker, a 32-year-old HIVer who was infected through tainted hemophilia products as a child. 'This is great news.' After tracking 2,435 HIV-positive adults to gauge whether--and by how much--combination therapy lengthened their lives, French scientists had the data to show that the higher one's CD4 count is maintained, the lower the risk of early death became. In fact, people who achieved and maintained CD4 counts of 500 or higher throughout six years or more of treatment had exactly the same life expectancies as their age- and gender-matched HIV-negative peers. The study results, reported in the September 2007 edition of the Journal of Acquired Immune Deficiency Syndromes, are particularly encouraging for doubtful HIVers like Hadley and Decker, both of whom spent years believing their deaths were inevitable and imminent. 'The longer I stayed alive, the more I felt like I was living past my expiration date,' Hadley says. But with undetectable viral loads and high CD4 counts, both men could very well be among those HIVers who, like the French patients studied, can expect to live to ripe old ages. And due to recent treatment advances, that group of long-living HIVers almost certainly includes most of those who were recently diagnosed, says James Carroll, MD, an HIV specialist at Legacy Community Health Services in Houston. He notes that the French study subjects were given the earliest available protease inhibitors, many of which were less potent, more likely to fail, and more prone to producing therapy-ending side effects than newer medications. Better meds--and improved ability to adhere to them--greatly increase the likelihood of a normal life span, Carroll says. That sort of upbeat news can go a long way toward alleviating the fears many HIVers experience on learning they're infected, says Ken Howard, a West Hollywood, Calif.-based psychotherapist and author of Positive Outlook: How to Successfully Manage HIV Today. 'There's still a large percentage of newly diagnosed people...who have that 'I'm going to die' feeling,' he says. 'Studies like this--as well as simply getting to know people like me who've lived with the virus for many years--certainly give them hope.' With that newfound hope and a potentially longer life span, however, comes a whole new set of medical issues associated with aging that have to be addressed, Carroll warns. Successful treatment also may necessitate establishing a new mind-set about the disease--what Howard calls 'getting used to living again.' Like many of Howard's patients, Decker found that planning for a long-term future did not come easily. But today he's eagerly anticipating being a senior citizen. 'My new life goal, which will be met,' he says with a laugh, 'is to be a 70-year-old guy in plaid pants, harassing skateboarders in the park.'