That’s a question I’ve been asked more than once as an HIV educator. The simple answer is: yes. The not-so-simple answer is: Everyone who gets HIV will get AIDS at some point. The thing is, we don’t know how long that will be. For some people, it seems to happen very quickly. There are also people who were diagnosed with HIV in the 1980s and are still healthy and have not received an AIDS diagnosis.

There are a number of factors that influence whether or not a person will progress to AIDS. For example, are they in good health otherwise? Do they take their medication faithfully? Do they receive good health care? Do they have a good support system in place? What is their general attitude? While all of these things impact whether a person who has HIV will progress to AIDS, there is no formula that says “If you do X, then you will not get AIDS.”

In order to get an AIDS diagnosis, a person must have HIV and either a CD4 (or T-cell) count below 200 or get one of several diseases, called AIDS-defining diseases because they generally occur primarily in people with HIV. Examples of those diseases are:
• Candidiasis of bronchi, esophagus, trachea or lungs
• invasive cervical cancer in women
• toxoplasmosis
• Kaposi sarcoma

A person can be pretty sick with one of those diseases and live. A person can have a low CD4 count and then they improve. Once a person has an AIDS diagnosis, they keep it, even if their health improves. There are a lot of reasons for that and some of them benefit the person with HIV. For example, if a person isn’t able to work because of AIDS and they are approved for disability based on the AIDS diagnosis, if they suddenly don’t have AIDS, then they will no longer be eligible for disability. If they then contract another AIDS-defining illness, they have to apply for disability all over again. They could go back and forth like that for years. Having a permanent diagnosis allows for more financial security. If a person lives in a state where participation in certain assistance programs depends on having a specific diagnosis, having a permanent diagnosis will also allow for continuity of medical care.

What I think the thing people really want to know is, “If I get AIDS, will I die?” The simple answer is “yes.” The not-so-simple answer is, “Yes, but not right now.” Because a person can be treated for those AIDS-defining diseases, having one does not mean the person is going to die soon. Having a low CD4 count does not mean a person is going to die soon. People can and do improve their CD4 counts.

A man I know who has HIV told me this about what he thinks about getting AIDS: “I know that there is a good chance that I will get sick and die. I can’t think about that too much or I’ll just get stuck there. Instead, I try to think of what proactive things I can do to maintain my health. That feels like I’m doing something rather than having things done to me.”

I think that’s good advice. By doing what they can to follow medical advice and to maintain overall good health, a person with HIV can have some measure of control over their disease.