Prognosis and duration of disabling effects

Without treatment, about 50% of people infected with HIV will become ill and die from AIDS over about 10 years.

The mortality for HIV positive people has fallen from about 30% per year to about 2% since the introduction of HAART. The average survival of a person starting HAART is now probably 20 years or more. One study from Denmark has shown that a newly infected person at age 25 is now expected to live to 57.5 years or 63.9 years if not co-infected with hepatitis C. This compares with a life expectancy for a non-HIV infected person of 76.2 years.

If evidence shows that the customer has HIV / AIDS with Hepatitis C then go to Viral Hepatitis guidance for additional information.

A poorer prognosis in HIV positive people starting treatment i.e. an increased probability of progression to AIDS is associated with:

• A lower CD4 count and higher plasma viral load
• Advanced age
• Infection through injecting drug use

People with the most favourable prognostic factors are estimated to have a 3.5% chance of progression to AIDS or death within 3 years -:

• aged < 50 years old
• not infected through injection drug use
• viral load < 100 000 copies/ml
• CD4 cell count > 350 /µl on initiation of HAART

People with the most unfavourable prognostic factors are estimated to have a 50% chance of progression to AIDS or death within 3 years -:

• Severe seroconversion illness
• aged ≥ 50 years old
• infected through intravenous drug use
• viral load ≥ 100 000 copies/ml
• CD4 cell count < 50 /µl on initiation of HAART
• Inability to take HAART/ART or poor compliance
• Drug resistant virus
• Other poor social circumstances

Once the claimant’s condition has deteriorated to the extent that care and mobility needs are established it is likely that there will be a subsequent deterioration, perhaps leading to death. However, the progress of the illness may not become clear until two years after the onset of the diagnosis of advanced HIV.

All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.

Amended November 2008