Thanks for your question.
This is a common dilema posed to me by many newly diagnosed persons with HIV. Prior to the advent of potent HIV therapies, the AVERAGE survival for persons with CD4 counts below 200 was around 3-4 years.
We can now propose that survival is much greater-- how much greater is conjecture, but I'd be willing to estimate that we're talking about decades of survival. This assumes many things: first is access to good and up to date health care, access to medications, lastly is a social and medical situation that facilitates excellent adherence to treatments.
If these things are in place, we see excellent and durable response to combination antiretroviral therapy. In our practice, over 85% of persons achieve undetectable viral loads when started on their first HAART regimen; this is almost always accompanied by increased numbers of CD4 cells (i.e. immune reconstitution). In fairness, it is also important to recognize that we have a generally very adherent patient population, not much in the way of active substance abuse nor severe psychiatric disease. Populations of patients who have more of these negative risk factors are less likely to achieve our virologic and immunologic goals.
As for buying a home and starting a family, these are more complex issues (particularly the later)--indeed issues that are complicated even for the HIV-negatives in our communities, and probably beyond the scope of this forum.
Nevertheless, the picture is one that I feel strongly is a good one. With careful medical monitoring, hard work (pill taking) and just a little of luck, I see no reason why your friend should not be able to plan for all that you've described.
Hope this is helpful. BY
