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How has Magic Johnson survived with HIV?

Magic Johnson in 2018
Magic Johnson made his HIV diagnosis public early and has championed HIV and AIDS prevention causes ever since. (Image credit: John Lamparski / Contributor via Getty Images)

Magic Johnson is a former professional basketball player who was diagnosed with human immunodeficiency virus (HIV) after a preseason physical for his team, the Los Angeles Lakers, in 1991. On Nov. 7, 1991, Earvin "Magic" Johnson shocked the world when he announced that he had contracted HIV, the virus that causes acquired immunodeficiency syndrome (AIDS). At the time HIV was still massively misunderstood and stigmatised and there was uncertainty as to what this could mean for his future life prospects.

"Many people [diagnosed] with HIV live many years with few serious effects on their health. The average period between infection with the human immunodeficiency virus and diagnosis of […] AIDS is now ten years, according to experts," wrote Mark Heisler of the Los Angeles Times on Nov. 8, 1991, reacting to Johnson's announcement.

Over 30 years later, the now-62-year-old Johnson is going as strong as ever in his roles as a sports analyst, businessman and HIV activist. In 1991, when most of what people knew about HIV/AIDS was that it led to death at a young age, this outcome might have seemed impossible.

Today, thanks to advancements in antiretroviral drugs, the life expectancy of a young person diagnosed with HIV is not dissimilar from that of a similarly aged person without HIV, according to Healthline. It is precisely these kinds of drugs that have helped Magic Johnson manage the disease and have made HIV a chronic health condition rather than a fatal disease.

"There is nothing unique about Magic," Spencer Lieb, senior epidemiologist and HIV/AIDS research coordinator for the Florida Consortium for HIV/AIDS Research told Live Science. "There are still people alive and kicking and doing very well 20 and 30 years after infection." 

Lieb said that in the state of Florida alone, hundreds of patients have lived full lives since being diagnosed with HIV in the early 1980s, when the first confirmed AIDS cases were confirmed in the United States. But while Johnson and many others are able to manage their condition, many others are not as fortunate. According to research and estimates by the Centers for Disease Control and Prevention, as of 2019 about 1.18 million Americans have HIV, and 13 percent of them are undiagnosed. Approximately 36,000 people are diagnosed with HIV each year, and more than 15,000 die annually, although these deaths can be from any cause, not necessarily from an AIDS-related illness.

Managing HIV

illustration of HIV particles in bloodstream

HIV is now considered a chronic health condition that can be managed with the right drugs and a healthy lifestyle. (Image credit: Science Photo Library - SCIEPRO via Getty Images)

Despite new advances in medical science HIV remains incurable thanks to "the presence of a latent viral reservoir. During the life cycle of the virus, HIV integrates into the host DNA. A subset of integrated HIV provirus remains transcriptionally silent, producing neither viral proteins nor viral progeny, until reactivation by various physiologic stimuli. This latency of HIV allows some infected cells to escape immune detection and elimination, and these latently infected cells constitute the viral reservoir," wrote Nathan W. Cummins, MD and Andrew D. Badley, MD for Mayo Clinic Proceedings in 2015.

The key with Johnson and others has been preventing their incurable disease from progressing into AIDS.

Upon infection with HIV, a person's immune system kills off nearly all of the virus and infected cells. But some small number remain, and over time, those HIV cells replicate, attacking the immune system in seven stages, according to the National Institute of Health's HIV info page. This is a gradual process known as the HIV life cycle and it is by blocking the virus at each stage of this process that it can be prevented from advancing to AIDS.

Researchers have developed a number of powerful drugs to help people like Johnson block and contain the virus. The key weapon in the beginning was a regimen of three or four antiretroviral drugs, collectively known as antiretroviral therapy, or ART.

"They told me that the three-drug combination was going to save my life, and they were right," Johnson told The Guardian in 2021. "As we talk today, right now, I'm thinking, 'Wow' – it’s been 30 years and I'm still here, healthy. Everything has gone right. There was one drug then, now we have 30-something drugs."

One of Johnson's doctors who helped pioneer the treatment placed him on the then-experimental drug cocktail in 1994, about a year and a half before it came into widespread use in 1996, according to the Daily Beast.

"Magic got a jumpstart on experimental drugs before they were released to the general public," Lieb told Life's Little Mysteries, "but there were many people in clinical trials benefitting at the same time."

HIV medicines

HIV spreads by hijacking a subset of white blood cells called CD4 cells or T cells, which are the body's first line of defense against foreign invaders, and using the cells' DNA to make copies of itself or replicate; in this process, these T cells get destroyed, according to Healthline. The most common drugs in the ART regimen target two of the enzymes that HIV uses to replicate itself.

The first enzyme, called reverse transcriptase, turns the virus' genetic instructions encoded in a single RNA strand into double-stranded DNA. In scientific terms, this mode of replication classifies HIV as a retrovirus, hence "antiretroviral" drugs.

The second enzyme, known as protease, creates new, functional HIV particles by cutting up the proteins produced by our hijacked cellular machinery.

Medication can disrupt these processes, and to that end, Johnson is currently taking reverse transcriptase inhibitor and protease inhibitor drugs, which are contained in the pharmaceuticals Trizivir and Kaletra, respectively, according to the Daily Beast.

These and other HIV-fighting drugs are "hideously expensive," said Lieb. "High ART costs are among many structural barriers that lead to poor treatment access and adherence, contributing to suboptimal HIV outcomes in the United States," according to a report published by JAMA Internal Medicine in 2020.

Public and private medical insurance, as well as various assistance programs, make the medicines more affordable and available to the vast majority of patients in the United States and other parts of the world. It is a "myth," said Lieb, that Johnson, who is wealthy, is buying himself special treatments.

Living with HIV

PrEP pills

As well as drugs to help manage HIV we now have drugs such as Pre-Exposure Prophylaxis, commonly known as PrEP, that can prevent transmission in the first place. (Image credit: YakubovAlim via Getty Images)

By taking the right regimen every day, most people living with HIV can see the number of virus particles in a sample of their blood, or viral load, become undetectably low.

Not only does a low viral count stave off symptoms of HIV and AIDS, but it also slashes the odds of a randomly mutated copy of the virus emerging that can prove resistant to the therapy. Furthermore, a low viral load severely reduces the risk of transmitting the virus to others.

Yet even without modern drugs, in rare instances a person living with HIV can manage on their own to keep AIDS at bay. These "long-term nonprogressors" or "elite controllers," estimated at as few as one in 500, have lived for decades with HIV, despite not being on antiretroviral therapy.

It is not known if Johnson is among this "scarce breed," as Lieb called them, but more than likely "without medications, he'd be progressing."

Researchers continue to study long-term nonprogressors to get insights on HIV resistance that could help the 37.7 million people battling the virus, the current estimate of UNAIDS according to HIV.gov.

Public perception of HIV

Magic Johnson holding the Walter A. Brown championship trophy

Magic Johnson holding the Walter A. Brown championship trophy after winning the NBA title in 1980 with the Los Angeles Lakers. (Image credit: Focus On Sport / Contributor via Getty Images)

One of the most important contributions Johnson has made to people with HIV is making people more aware and understanding of the virus. Johnson announced his retirement from the NBA and made his diagnosis public very quickly and then opened up about his experience.

"My ignorance could cost me my life, but I wanted to try and ensure that no one else would become infected with HIV for the same reason" Johnson wrote in Sports Illustrated on November 18, 1991.

"I said that because I had tested HIV-positive, I was retiring from the NBA. I also said that I was going to become a spokesperson in the fight against the human immunodeficiency virus and an advocate for practicing safe sex by using condoms. I also said I was going to beat the disease. And I will," Johnson wrote.

He lived up to that promise by making regular appearances, giving interviews and being an activist for HIV and AIDS organisations. "Johnson went on to attack the HIV stigma with the same passion he displayed on the court, launching the Magic Johnson Foundation to raise awareness about the virus, then pushing Congress and the White House to spend money to fight the disease," wrote Nelson Oliveira for CBS News.

His approach acted as a "public-health catalyst," wrote Alexander Cardazzi, Joshua C. Martin, and Zachary Rodriguez in their 2021 paper "Information Avoidance and Celebrity Exposure: The Effect of "Magic" Johnson on AIDS Diagnoses and Mortality in the U.S." for West Virginia University, as they attempted to quantify the impact his announcement in 1991 had on heterosexual men getting tested for HIV.

Additional resources and reading

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Bibliography

Adam Hadhazy is a contributing writer for Live Science and Space.com. He often writes about physics, psychology, animal behavior and story topics in general that explore the blurring line between today's science fiction and tomorrow's science fact. Adam has a Master of Arts degree from the Arthur L. Carter Journalism Institute at New York University and a Bachelor of Arts degree from Boston College. When not squeezing in reruns of Star Trek, Adam likes hurling a Frisbee or dining on spicy food. You can check out more of his work at www.adamhadhazy.com.