Question:

Sir,
I have a 4 1/2 year old grandson who is HIV positive. He was born in Kenya and contracted the disease from his mother, who unfortunately passed away before we had a chance to get her to the States for treatment. My grandson is being treated and responds well to his medication. His virus count is below detectable levels and his T4 cell count is within the normal range. He is full of energy, like any other boy his age will be.

Is there any information to estimate what his life expectancy is? Is there a good probability that he will live long enough to go to high school or to college? What about the probability that he will have a family of his own?
I will appreciate any information you can provide me on this subject.

Answer provided by:

Lisa Capaldini, M.D.
Internal Medicine

It sounds like your grandson is in great shape now, and my hunch is that he will stay healthy indefinitely. I use the word hunch because we really don't KNOW the life-expectancy of healthy people with HIV infection. It's only been since 1996 that we've used adequately potent HIV therapies so we don't yet have long-term data (20 or 30 years) on the new generation of HIV positive kids and adults.

What I tell my healthy, adherent HIV patients is that while we don't KNOW, factually, their long-term prognosis, there is no reason to think it won't be the same as non-HIV-infected patients. I advise them to make life-choices (education, finances, family-planning) with the reasonable assumption that they WILL do well long-term.

Here are some of the unknown factors that will be sorted out over the next decade or two:

• Do the HIV drugs ever fail/"poop out" even in adherent patients (most of what has been labeled HIV drug failure is actually due to adherence problems); many of my patients remain on their initial HIV regimen and show no evidence of the drugs failing.
• Will the HIV drugs cause long-term complications that might cause health problems, e.g. glucose/lipid abnormalities causing heart disease?
• Are there any HIV-mediated immune disorders that normalizing T-cells won't correct, e.g. will women with HIV remain at higher risk for cervical cancer?

So there are the scientific uncertainties; in the interim, I encourage my patients that so far, so good: I'm thrilled your grandson is doing so well and wish him continued good health.

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