In recent years, life expectancies for people living with HIV have jumped up dramatically with increased access to ever more-effective antiretroviral therapy (ART). A new study, of people receiving care from the Kaiser Permanente health system in California, has found that between 1996/1997 and 2011, the life expectancy of people living with HIV after age 20 has increased by 178%—from 19.1 years to 53.1 years. “These findings confirm that ART has had a substantial impact on the survival of HIV patients, and suggest that early ART initiation and risk reduction strategies, such as smoking cessation, may further reduce the remaining gap in survival relative to HIV-uninfected individuals,” said Marcus and colleagues. This study is significant because it directly compared the life expectancies and measures of health of people living with HIV and HIV-negative people with equal access to health care (i.e., who were all receiving care from Kaiser Permanente in California). The researchers were able to compare similar people based on demographic information (gender, race and ethnicity) and measures of health like hepatitis infection history, CD4 count and use of drugs, alcohol and tobacco. Even though big gains in life expectancy were seen for people living with HIV, the researchers found that people living with HIV had lower life expectancies than HIV-negative people. Not having a history of hepatitis B or C, drug or alcohol abuse, smoking, and having a high CD4 count when starting ART decreased—but did not eliminate—the gap.Of note is the continuing disparity between white and Hispanic people living with HIV (who have higher life expectancies) and Black people living with HIV (who have lower life expectancies). Additionally, people with a history of using injection drugs who are living with HIV continue to have a lower life expectancy compared to men who have sex with men who are living with HIV and heterosexual people living with HIV.