Is 73 too young to die

AIDS: With HIV nobody has to die young anymore

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The HI virus is seldom a cause for good news, this is one. Thanks to modern drugs, people who are infected with the AIDS virus are living longer and longer. A twenty-year-old from Europe or North America with the virus who has been treated since 2008 now has a life expectancy of around 73 years, and a twenty-year-old 76 years. So they are almost at the normal cut. In principle, men and women from these regions who were born in 1988 can live to be around 78 years of age. Overall, HIV patients can now expect ten more years of life than they did 20 years ago.

An unprecedented medical success, about the international researcher in the magazine Lancet HIV to report (Antiretroviral Therapy Cohort Collaboration, 2017). Especially when you think of all the people for whom there was no rescue at the beginning of the global AIDS epidemic in the 1980s. Anyone who got the virus at the time will certainly develop AIDS - a disease that destroys the body's defenses to such an extent that other, mostly harmless viruses, fungi or bacteria torment the body until it finally gives up and the person dies.

The turning point came in 1996. The fatal diagnosis turned into a chronic disease with what medical professionals call HAART: Die Hohactive antiretrovirals THerapie has always suppressed the virus in patients' bodies, and so well that doctors can no longer detect HIV in the blood of many infected people. In the beginning, patients had to swallow different tablets for this, today a combination of them is often enough. One pill a day against AIDS.

Isn't AIDS that bad anymore?

Even if there has been neither vaccination nor cure so far, there is hardly any other drug therapy that has been able to better contain a global threat like AIDS in the past few decades. And it no longer stresses the body as much as it used to. "Newer drugs have fewer side effects, they mean fewer pills, better prevent the virus from multiplying and it becomes harder for HIV resistance to develop," the lead author of the new study, Adam Trickey from the University of Bristol, England, is quoted as saying. For him, antiretroviral therapy is the most important factor in making people with HIV live longer.

Trickey bases his statements on data from 88,504 HIV patients who started antiretroviral therapy between 1996 and 2010 in Europe and North America. Together with dozens of colleagues, he evaluated the results of 18 group studies. In the past 20 years, fewer people died of AIDS, but only if they were treated - and as quickly as possible.

The success of HAART is immense, but medical advances could also give the wrong feeling: AIDS is not that bad anymore. The fear of death of the 1980s has given way. Rightly. It is so important to recognize an HIV infection early on. Those who do not immediately start daily antiretroviral therapy for the rest of their life still run the risk of developing AIDS. One pill a day also sounds nicer than the truth: The virus always causes damage, whether it can be detected or not. HIV-positive people suffer from cancer more often than people without pathogens, and their risk of cardiovascular diseases is also much higher than those of HIV-negative people. And for those infected, it is more important to exercise and eat a balanced diet. Drugs such as tobacco or alcohol can also trigger more serious secondary diseases more quickly. And therapy alone will not eradicate AIDS.

The epidemic is out of sight

"With the further development of drugs, deaths among people living with HIV will hardly be able to be reduced any further in the future," says the doctor Trickey. It is much more important, for example, to take care of people who only find out about an infection late.

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"Concern is greatest among the world's most vulnerable populations," write Boston-based public health experts Ingrid Katz and Brendan Maughan-Brown in a comment on the life expectancy study. They include people in Sub-Saharan Africa, where AIDS kills most and HIV is part of everyday life. Not all are treated there because drugs are not available or because some reject the therapy in the mistaken belief that this is how they get sick in the first place. Here, too, the mortality of all those lucky enough to receive antiretroviral therapy falls (Boulle et al., PLoS Medicine, 2014). In Europe and North America, the often forgotten HIV patients are mainly drug users who became infected because they shared syringes.

Sven Stockrahm

Head of Knowledge and Editor Health & Digital, ZEIT ONLINE

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Nevertheless, it sounds as if people in rich industrial countries and especially in Germany have to worry less about AIDS. Not at all. You run the risk of being too careless with one of the most insidious pathogens in the world. How aware are most of what HIV means? Young people in particular should know. But is it still enough today to advertise condoms and dispel false fears that people infected with HIV are dangerous?