The outlook has never been better for people with HIV in the UK. With the right HIV treatment and care, most people can expect to have a near-normal life span.

In fact, a recent UK study showed that people living with HIV who have a good initial response to HIV treatment have a similar life expectancy to people in the general population. Specifically, a 50-year-old man who had a CD4 cell count over 350 and an undetectable viral load one year after beginning HIV treatment could expect to live to the age of 83. A 50-year-old woman in the same circumstances could expect to live to 85.

Even when the initial response to treatment was not quite so good – for example with a CD4 count between 200 and 350, or with viral load still detectable after one year – people with HIV were predicted to live well into their seventies.

Good access to effective HIV treatment that reduces viral load to undetectable levels and allows the immune system to recover is needed for a long life with HIV. People who start HIV treatment as soon as possible, are able to stick with it and who regularly attend the high-quality services provided by the NHS are likely to have a similar life expectancy to their peers who don’t have HIV.

In this situation, you are unlikely to fall ill or die as a direct result of HIV, but you might be affected by other health conditions and illnesses. Some of the most common health conditions that affect people living with HIV as they get older are raised lipids (blood fats), high blood pressure and depression. A number of people with HIV have diabetes, cancers, bone problems and other conditions. This is similar to the general population.

A wide range of factors affect your risk of developing these health conditions. Some of them are things you can’t change, like your age, a family history of certain diseases, or having HIV.

Other risk factors are within your power to change. You can expect to have a longer and healthier life if you don’t smoke, are physically active, have a balanced diet, maintain a healthy weight, avoid excess alcohol or drug use, remain socially connected and keep your mind active.

The risk of having health problems like heart disease and cancer increases for everyone as they get older. The focus of your healthcare is likely to change as your doctors pay more and more attention to a wide range of health issues as well as HIV.

The most common health conditions that affect people living with HIV as they get older are similar to those affecting people who don’t have HIV. They are described in Other health issues.

Your healthcare should include regular screening for these conditions. The most important aspects of their prevention and treatment are the same as for people who don’t have HIV.

Many people ask whether HIV speeds up the ageing process. In other words, do people living with HIV have a decline in physical function and develop age-related conditions at younger ages than their peers?

There is still a lot that we don’t know about this question. There is no consensus among scientists on the issue of HIV and ‘premature ageing’.

We do know that people with HIV are a little more likely to develop some health conditions than other people. This includes heart disease, diabetes, kidney disease, liver disease, bone problems and some cancers. But they don’t necessarily have them at a much younger age. It’s more the case that whatever the age group, people with HIV have slightly higher rates of these conditions than other people of the same age.

Scientists are still trying to work out why this is the case. Part of the explanation may be that although today’s HIV treatment is quite safe, some of the anti-HIV drugs which some people took in the 1990s and early 2000s occasionally had harmful effects on cholesterol, the kidneys, the liver and the bones.

Also, while taking HIV treatment strengthens the immune system and prevents many HIV-related illnesses, it may not fully restore health and reverse all damage to the immune system. HIV may continue to cause ongoing, low-level inflammation and immune activation. These unhelpful responses of the immune system to HIV are likely to contribute to a wide range of health problems.

There are other reasons why people with HIV have high rates of these health conditions. Things that are not directly linked with HIV can raise the risk of health problems in people living with HIV. In particular, the lifestyles and life experiences of people living with HIV are often not identical to those of the general population. For example, people with HIV are more likely to smoke and have high levels of stress than other people, which may partly explain the higher rate of heart disease in people with HIV.

That means that simple comparisons between HIV-positive people and HIV-negative people can be misleading. In fact, in the most carefully conducted studies, which compare very similar groups of HIV-positive and HIV-negative people, the health differences between the groups are quite small. Moreover, it does not appear that people with HIV are ageing faster than their peers who don’t have HIV.

Studies show that HIV treatment works well for older people. Viral load drops to an undetectable level (the aim of treatment) just as quickly as it does in younger people. Older people are often better than younger people at taking their medication as prescribed.

On the other hand, people who start treatment over the age of 50 may have a slower and less complete restoration of their immune system. The CD4 cell count doesn’t always rise as quickly as it does in younger adults.

As well as preventing HIV-related illnesses, effective HIV treatment helps protect against heart disease, cancer, kidney and liver disease. Among people living with HIV, rates of these conditions are lower in people who take HIV treatment than in people who do not.

Taking HIV treatment is one of the most important things you can do to protect your overall health.

If you have other health concerns as well as HIV, this can affect the choices you and your doctor make about which HIV drug combination is right for you.

• There could be interactions between one of your anti-HIV drugs and a medicine you take for another health condition. There’s more information on this below.
• As you get older, your body may change. The liver and kidneys may work less efficiently, affecting the way a drug is processed in the body. Because of weight loss, decreased body fluid or increased fatty tissue, medicines may stay in the body longer and cause more side-effects. Occasionally, your doctor may need to adjust your dose.
• Some specific anti-HIV drugs are associated with a slightly increased risk of developing some health conditions, or could make a health condition worse for you. If this is the case, you will usually be able to take a different anti-HIV drug.

For these reasons, your choice of anti-HIV drugs may need to be tailored to your specific situation. You may need a different dose of one of your medicines. This may mean that a single tablet, which contains several drugs in fixed quantities, might not always be the right choice for you. You might need to switch from a drug combination that you have got used to.

In the UK, standards for HIV treatment and care are set by the British HIV Association, the professional association for HIV doctors. Their guidelines recommend that doctors exercise caution in prescribing the following anti-HIV drugs to people who have specific health conditions or have risk factors for that condition.

• Depression and other mental health problems: efavirenz.
• Heart disease: abacavir, lopinavir or maraviroc.
• Kidney disease: tenofovir disoproxil or atazanavir.
• Bone problems: tenofovir disoproxil.

The more health conditions you have, the more medication you may need. And the more medication you take, the greater the possibility of experiencing drug interactions and side-effects.

A drug interaction is when one medicine affects how another medicine works. For example, when taken together, one of the drugs may not be fully effective or its side-effects could be worse.

Before starting a new medicine, always ask your doctor or pharmacist: Could the new drug interact with one of the other drugs I am already taking?

You should tell them about everything else you take – medicines prescribed by another doctor; over-the-counter medicines (including inhalers and nasal sprays); supplements, herbal and alternative treatments; and recreational drugs. This will be easier if you bring an up-to-date list of all your medication with you.

The University of Liverpool provides an online tool to check for interactions between anti-HIV drugs, other medications and recreational drugs. Visit www.hiv-druginteractions.org/checker or download the Liverpool HIV iChart app for iPhone or Android.

It’s very helpful to have an annual medication review. This involves one of your pharmacists or doctors taking stock of everything that you take and checking for interactions and side-effects. They will check that the medicines you are taking are still right for you.

HIV is a young person’s disease.

People acquire HIV at all ages: in 2016, 19% of people newly diagnosed with HIV in the UK were over the age of 50. And thanks to the success of HIV treatment in keeping people alive, the population of people living with HIV gets a little older each year. In 2016, 38% of people receiving HIV treatment were over the age of 50.

If I switch drugs and I’m not happy with my new combination, I won’t be able to switch back.

It depends on your reason for changing treatment. If you are switching because you have drug resistance or your treatment has not been keeping your viral load to an undetectable level, then you definitely need a new treatment. It would not be a good idea to return to your original drugs.

However, if you are switching because of side-effects, you will have more options. Sometimes people are nervous about changing treatment, worrying that their new treatment will also have side-effects and that these could be more difficult to live with. This is unlikely, but if it does happen, you’ll probably be able to go back to the anti-HIV drugs you were on before.

After several years of HIV treatment, it’s inevitable that I’ll develop resistance to anti-HIV drugs and run out of treatment options.

You can take the same drug combination for years and years, without problems occurring. In fact, if you adhere to your treatment and maintain an undetectable viral load, your HIV cannot become resistant to the drugs that you are taking.

HIV will always be the most important health issue you have to deal with.

Without treatment, HIV is life threatening. But highly effective treatments are available, making HIV relatively straightforward for a specialist doctor to manage. You may have other health conditions which have a greater impact on your day-to-day life or which are more complicated to treat. You may sometimes need to prioritise other health issues over HIV.

Lots of older people living with HIV have dementia.

You may have heard about studies that use cognitive tests to detect subtle changes in memory and thought processes. Some have shown small differences between HIV-positive and HIV-negative people. In most cases, these minor declines aren’t noticeable in daily life.

This should not be confused with dementia, which is a severe impairment that interferes with your daily life and independence. Dementia can have a range of causes, including Alzheimer’s disease and other conditions that reduce blood flow to the brain. HIV-associated dementia is now hardly ever seen except in people who are diagnosed with HIV at a very late stage, with a very low CD4 count. For more information, see Cognitive impairment in Other health issues.

• Life expectancy for people living with HIV Simple factsheet
• HIV and the ageing process Simple factsheet
• Taking your HIV treatment Information booklet
• Multiple medications and drug interactions Simple factsheet