Patients Diagnosed with HIV Are Living Long, Healthy Lives, Thanks to Vastly Improved Testing and Treatments

HIV (human immunodeficiency virus) infection still has a long way to go before it can be declared eradicated from the planet. However, vastly improved testing and treatment have changed the face of the disease, transforming it from deadly to manageable. 

An estimated 1.2 million people in the U.S. are HIV-positive, according to the most recent data from the Centers for Disease Control and Prevention (CDC), but approximately 13 percent of that number are unaware of their diagnosis. That’s a problem, says Dr. Benjamin Scallon, a primary care internist and Assistant Professor of Clinical Medicine at Weill Cornell Medicine. 

Knowing your HIV status is the key to unlocking the behaviors, tests and medications that will keep you safe and healthy, Dr. Scallon says.  

The U.S. Preventive Services Task Force—an independent, volunteer panel of national experts in disease prevention and evidence-based medicine—recommends getting screened at least once for every single person alive. The task force, along with primary care and infectious disease specialists across the country, recommends more frequent testing for people at higher risk of contracting HIV. 

How is HIV transmitted? 

HIV can be transmitted only through specific bodily fluids from a person who has the virus. These include: 

  • blood 
  • semen 
  • rectal fluids 
  • vaginal fluids 
  • breast milk 

For transmission to occur, these fluids must come into contact with the mouth, vagina or rectum or be injected directly into the blood stream. HIV is most commonly transmitted through the sharing of needles to inject drugs or through anal or vaginal sex. 

Who is at risk? 

According to the most recent data from the CDC, the following groups are at disproportionate risk for contracting HIV: 

  • Gay, bisexual and other men who have sex with men (MSM) 
  • Black, Latino and Indigenous men 
  • Black women 
  • Transgender women 
  • Youth aged 13–24 years 
  • People who use injection drugs 

Regarding the last group on the list, the opioid epidemic has led to an increase in HIV incidence—new infections—due to a rise in injection drug use. Sharing needles is a risk factor for contracting HIV, as well as hepatitis B and C. 

The importance of getting tested 

Some people are still reluctant to get tested, says Dr. Scallon. “That, at least in part, has to do with the stigma associated with HIV infection.  

“Anecdotally,” he continues, “since moving to New York City, I’ve noticed that more and more patients are willing and eager to seek screening, even if they don’t fall into a ‘high-risk’ category. It’s encouraging to see New Yorkers act collectively for the greater good.” 

Regrettably, there are still people who are reluctant to get screened, despite major advances in prevention and treatment. 

What preventive measures can people take to avoid contracting HIV and protect others? 

It’s crucial for patients to know their status. HIV treatment has advanced light years over the past several decades, Dr. Scallon says. Patients living with HIV can expect to have normal life expectancy, if they’re maintained on highly active anti-retroviral therapy (HAART). Their viral load will drop to negligible levels, with a zero percent chance of passing the virus to their partners.  

The best ways to prevent HIV infection are: 

  • Get tested often.  
  • If you have suspected ongoing exposure to the virus, you can and should take a medication called pre-exposure prophylaxis (PrEP). 
  • If you use injection drugs, take advantage of a clean needle exchange program and seek treatment for opioid use disorder. 

PrEP and PEP 

When taken consistently, PrEP can prevent HIV infection. However, people on this medication still require regular, frequent monitoring of their HIV status. If used inappropriately by patients who already have HIV, PrEP can be harmful and even induce resistant strains of the virus.That’s why it should only be used by people who are HIV-negative. 

There’s also a medication called post-exposure prophylaxis, or PEP. People who have already been exposed to HIV, or suspect as much, are urged to take PEP as soon as possible, preferably within 48 hours of exposure. 

The HAART of the matter 

Large-scale prospective studies of patients with HIV on today’s anti-retroviral therapy (HAART) found no transmission of the virus to their sexual partners. Zero.  

“We call that phenomenon U equals U, which means ‘undetectable=untransmissible,’ Dr. Scallon says. As long as patients remain on HAART, it’s almost as if they don’t have HIV. Their viral load drops to zero, and their ability to transmit it drops accordingly. 

U=U lends further support to the idea that the most important step in preventing and, eventually, eradicating HIV is knowing everyone’s status and offering anti-retroviral therapy to all who need it. 

The persistence of stigma 

HIV disproportionately effects disadvantaged groups who have been historically ostracized, both within the medical community and by society at large, Dr. Scallon explains. But accepting stigma as a permanent feature of society is unwarranted. 

“Societies that are more inclusive and tolerant do better than repressive, punitive societies,” he says. “The positive impact of harm reduction policies is clear, based on all available evidence. The more open we are as a society with respect to safe sex practices and safe intravenous drug use, and the more we support the use of medications like PrEP and anti-retrovirals, the lower the HIV positivity rate will be.” 

Toward eradication 

However, a greater effort will be needed to eradicate HIV in the U.S., focused mainly on testing and treatment. Globally, says Dr. Scallon, there are regions where homosexuality is criminalized and punishment of drug use is draconian. These societies continue to experience far higher rates of HIV incidence compared to more tolerant societies. 

Still, we’ve made enormous progress in decreasing the numbers of HIV infection through testing and treatment. To benefit from these advances, it’s critical to know your HIV status. If you haven’t gotten tested yet, it’s time to step up and make the decision to get tested ASAP. 

You can discuss testing and sexual health issues with your primary care doctor. Make an appointment here.