What Does Charlie Sheen’s New Normal Look Like? The Reality of Living With HIV Right Now

“It’s a hard three letters to absorb,” Charlie Sheen said to Matt Lauer on the Today show this morning, announcing that he is HIV positive. What’s more, he revealed, he has paid millions of dollars in extortion to blackmailers in the four years he has had the diagnosis. But while the disease—often transmitted by unprotected sex and needle sharing—is still freighted with stigma, Sheen’s prognosis is infinitely better than it would have been during HIV’s earlier days.

When Magic Johnson announced in 1991 at age 32 that he had the virus and was stepping down from the Los Angeles Lakers, his fans went into mourning. The country was still reeling from the devastating AIDS crisis of the 1980s that claimed legions of victims, including Keith Haring, Liberace, and Perry Ellis. AZT, the first major drug treatment for HIV—familiar to anybody who saw Dallas Buyers Club—hit the market in 1987. It was a toxic compound that carried serious side effects and had limited efficacy; early patients were routinely told that the medicine would buy them an extra year of life.

The reality for anybody with HIV/AIDS today is that the virus is effectively a manageable, chronic disease rather than a death sentence. There are currently 1.2 million people with HIV in the United States, with 50,000 new infections reported each year. (At its height in the ’80s, 130,000 new cases arose annually.) The big breakthrough in treatment came in 1996, when combination therapy, known as highly active antiretroviral therapy (HAART), was approved. “The treatment is extremely effective,” says Kenneth Mayer, M.D., a professor of medicine at Harvard Medical School and the medical research director of the Fenway Institute, Fenway Health, Boston. Mayer has been involved in the field since the beginning of the AIDS epidemic. “You can be on this pill the rest of your life and your life expectancy would be comparable to people who aren’t HIV positive.”

What is it, exactly? Essentially, doctors have found around 30 medicines that suppress the virus. Rather than taking one medication, such as AZT, patients go on a regimen of three substances (which come in a single daily pill) tailored to their individual medical history. HAART is less toxic, presents fewer side effects, and, most important, is far more successful at suppressing the virus than any single agent. Recent studies also show that when patients are on combination therapy, the likelihood of transmission is minimal—even through unprotected sex. Because of this, doctors recommend that patients start treatment as soon as HIV is detected.

There is no cure for HIV in sight—though a new study shows that medications taken to prevent infection in high-risk people are extremely successful: During a year-long trial of pre-exposure prophylaxis (PrEP), only 2 out of 400 people became infected—and those two subjects didn’t take the medication every day as instructed.

“In the early ’80s, the median survival was a year to a year and a half,” says Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases. “Today you can predict that a 25-year-old person would live an additional 50 years.”

His advice to Sheen? “Plenty of rest, exercise, maintain a good diet. Just keep healthy.”

The science is on Sheen’s side. Magic Johnson turned 56 in August.

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