Human immunodeficiency virus (HIV) attacks the body’s immune system. Over time, it weakens your ability to fight off infections and diseases. If untreated, HIV can progress into acquired immunodeficiency syndrome (AIDS), the most advanced stage of infection.

Although there is no cure, proper medical care allows people with HIV to live long, healthy lives. Today, treatment is highly effective—but it wasn’t always this way.

Timothy Schacker, MD, professor of medicine and director of the Program in HIV Medicine at the University of Minnesota, reflected on the early days of HIV care. In the 1980s and early 1990s, most patients diagnosed with HIV faced a poor prognosis. But treatment has advanced rapidly. Here’s what Dr. Schacker says he wishes he had known about the progress of HIV care.

Early Understanding of HIV

When HIV was first identified, very little was known. Clusters of unusual infections appeared in men who have sex with men, linked to profound immunosuppression.

In medical school at the time, Dr. Schacker recalls learning only how to manage opportunistic infections such as pneumonia. There were no direct therapies for HIV itself, and the outlook was grim.

Opportunistic infections are illnesses that become more frequent and severe in people with weakened immune systems, such as tuberculosis or fungal infections.

Advances in HIV Testing

At first, no test existed to confirm HIV infection. Basic science research pushed forward to isolate the virus, leading to the development of blood tests.

Today, routine testing is available for people at risk due to sexual exposure, injectable drug use, or other factors. HIV screening is now a standard part of medical care, with rapid tests providing results in minutes.

Advances in HIV Treatment

According to Dr. Schacker, HIV treatment is “a real success story.”

  • Early years: Only one or two antivirals existed, with limited effectiveness. The average time from infection to AIDS was about six years. Treatment mainly focused on delaying progression and managing drug side effects.

  • Past decades: Patients often took 15–20 pills daily, scheduled at different times.

  • Today: Most people take just one pill per day, which contains three drugs. Side effects are minimal, and outcomes are far better.

Effective antiretroviral therapy (ART) allows patients to achieve viral suppression and lead near-normal life spans.

Safer Practices and Prevention

In the 1990s, counseling patients meant focusing on preventing HIV transmission to others. Today, prevention tools like PrEP (pre-exposure prophylaxis) are available. PrEP is taken orally or as an injection and greatly reduces the risk of acquiring HIV.

Counseling has shifted to broader discussions of safe sex practices and overall sexual health.

HIV and Aging

One of the most unexpected developments is that many people with HIV are now living into older adulthood. Specialized geriatric HIV clinics are emerging, managing long-term complications while supporting healthy aging.

Talking About Prognosis

The outlook for people with HIV has changed dramatically. Dr. Schacker now tells patients that HIV is a chronic, manageable condition. While rare cases don’t respond to therapy, the majority can expect a normal or near-normal life span with effective treatment.

A Quick Review

HIV was once considered a death sentence, but advances in testing, treatment, and prevention have changed the narrative.

  • Early HIV care focused only on opportunistic infections.

  • Now, one daily pill can control HIV, with minimal side effects.

  • Prevention strategies like PrEP are highly effective.

  • People with HIV can live long, healthy lives with proper care.

HIV remains a lifelong condition, but modern medicine allows patients to manage it successfully and look toward the future with hope.