Four decades ago, the prognosis was pretty grim for those diagnosed with HIV, the virus that causes AIDS. A rigorous and difficult to tolerate drug regimen and a short life expectancy were the norm.
But today, with advances in prevention, diagnosis and treatment, people are living with the virus much longer and remaining healthy, and we’re nearing its potential elimination.
To support this positive momentum, it’s important to continue sharing facts about the progress that’s been made preventing and treating HIV.
There’s medication available to prevent HIV in high-risk people
Although a preventive vaccine for HIV isn’t yet available, there’s medication that can be used to prevent HIV infection among those at high risk.
It’s called pre-exposure prophylaxis, or PrEP, and there are several types now available. One form combines two oral drugs – tenofovir and emtricitabine.
In addition to a daily pill, there are long-acting injectable medications that can be administered every two months (cabotegravir) or every six months (lenacapavir).
The daily pill form is more than 95% effective, and clinical trials show that long-acting injectables for PrEP are even more effective due to improved adherence. This is due to the elimination of user error or reluctance because users don’t have to take a pill every day.
If you’ve recently been exposed to HIV, there’s emergency medical treatment that can prevent infection
If a person has possibly been exposed to HIV via a contaminated needle, through unprotected sex or on the job, the risk of acquiring HIV is greatly reduced if an antiretroviral treatment cocktail is started within 72 hours of that exposure.
The emergency medication is called post-exposure prophylaxis, or PEP, and it must be started within 72 hours of exposure and taken for 28 days to be fully effective. Recent improvements have made it easier to take by combining multiple medications into one daily tablet.
The sooner PEP is started, the more effective the prevention intervention.
Life expectancy for people with HIV is about the same as people without HIV
The antiretroviral drugs that treat HIV have become so effective and well tolerated that most people in treatment are able to keep the virus completely suppressed and preserve the immune system. This has resulted in a steady increase in life expectancy.
Treatment guidelines around the world recommend starting treatment as soon as possible after diagnosis to stop, and even reverse, immune decline.
The population of people living with HIV is aging
As people with HIV live longer, their overall population is aging. An estimated 54% of Americans living with diagnosed HIV are age 50 or older; 42% are 55 or older; and 15% are 65 or older, according to a 2022 report by the Centers for Disease Control and Prevention (CDC).
Goals of treatment and research are to find ways for people with HIV to longer, higher-quality lives, and to avoid complications that can come as a result of virus-related inflammation.
These include accelerated aging and higher risk for multiple types of cancer, heart disease and stroke.
The multi-center clinical trial REPRIEVE demonstrated that cholesterol-lowering drugs, called statins, help reduce chronic inflammation in HIV patients – even in those who don’t have high cholesterol.
Another ongoing trial is exploring whether certain medications can prevent early frailty, which comes with symptoms like reduced mobility, difficulty standing, reduced grip strength and cognitive decline.
HIV treatment has steadily become more potent, convenient and well tolerated
Treatment of HIV requires the use of a “cocktail of drugs” to effectively control the virus. In the past, taking that cocktail required regimens consisting of many pills, multiple times a day. These regimens were associated with numerous troublesome side effects.
We now have multiple regimen combinations that are very potent but produce minimal, if any, side effects.
Current medications combine multiple drugs in convenient one pill, once-a-day regimens or injections that can be administered every two months.
In the near future, we expect to be able to offer injectable treatments that can be administered just twice a year, as well as tablets that can be taken daily, weekly or monthly.
This will allow us to individualize treatment according to people's lifestyles and preferences, so that no one is left behind.
Patients on treatment who maintain fully suppressed virus can’t transmit HIV to others
Multiple studies show that, if a person with HIV is on treatment and has undetectable virus, they cannot transmit the virus to other people.
As such, we now consider treatment of HIV a form of prevention and emphasize the importance of starting treatment as soon as a patient is diagnosed (Undetectable=Untransmittable, or U=U). If everyone living with HIV is on treatment, then we’ll stop forward transmission of the virus and end the HIV epidemic.
About one in seven people living with HIV is unaware of their status
While the percentage of people with HIV who are aware of their status has increased steadily, we still have a way to go.
HIV testing has become very sensitive, and rapid tests that provide results in about 40 minutes can detect an infection that was very recently acquired.
While CDC guidelines recommend HIV testing at least once for everyone between the ages of 13 and 64, too many people who have HIV don’t become aware of their diagnosis until the disease is advanced or AIDS has developed.
It’s important to promote and normalize HIV testing for everyone, so that all people with HIV can be diagnosed and start HIV treatment as soon as possible.
Early treatment can keep HIV at undetectable levels
People living with HIV can keep the virus at undetectable levels in the blood as long as they take their antiretrovirals consistently as prescribed. A person who starts treatment during acute infection – very soon after acquiring HIV – could even limit the establishment of dormant HIV infection, called the HIV reservoir.
Current research also is developing treatment strategies to reactivate the dormant HIV reservoir so that cells with inactive infection can be targeted and eliminated by antiretroviral and immune therapies. This could potentially result in eliminating the virus to produce a “functional cure,” keeping the virus in remission without the need for long-term antiretrovirals.
Testing is particularly important during acute HIV, because symptoms often mimic those of flu or other viral syndromes. These include night sweats, fever, rash, sore throat, enlarged lymph nodes. The symptoms do resolve after a period of time. During acute infection, viral loads are very high and transmission to partners is more likely during this period.
People experiencing these symptoms should get tested, because it could be acute HIV.
You may also consider asking for an HIV test as part of an annual exam.
If global efforts are allowed to continue, we should see an end to the HIV epidemic
UNAIDS, the Joint United Nations Program on HIV and AIDS, has set a global target of “95-95-95” for testing and treatment. The program seeks to achieve diagnoses in at least 95% of all people living with HIV, providing treatment to 95% of those diagnosed, and maintaining complete viral suppression in 95% of people being treated.
As of 2024, 87% of people living with HIV knew their status, 89% of people with HIV were on treatment, and 94% of those on treatment had viral suppression.
While the 95-95-95 goal has not been met in the U.S. as a whole, there are several U.S. cities that have already achieved the previous 90-90-90 targets, including San Francisco and New York City. It has translated into a decreasing HIV incidence year after year.
For this to continue, we’ll need programs that ensure people everywhere have equitable access to treatment.
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