Life expectancies close to 80 years for young people starting HIV meds early
Two developments have transformed the HIV epidemic: potent HIV medications and the recommendation that everyone living with HIV start and stay on treatment. As a result, people living with HIV are living longer, and the estimated life expectancies of HIV-positive people have risen dramatically—at least in places where HIV testing, treatment and care are readily accessible.
A study published in Lancet HIV in 2017 examined the life expectancies of people living with HIV by analayizng 18 data sets from European and North American cohorts of people living with HIV.
The researchers examined data from 88,504 people living with HIV who started antiretroviral therapy (ART) at least three years before 2012. They analyzed CD4 and viral load information from participants, in addition to mortality information including cause of death.
Overall life expectancy
Overall, life expectancy in people starting treatment has increased significantly in the modern age of antiretroviral therapy. Between 1996 and 2010, life expectancy for people living with HIV increased by about 10 years for men and women, in Europe and North America.
For a 20-year old person starting ART between 2008 and 2010, with a CD4 count of more than 350 cells/mL one year after starting ART, the life expectancy was estimated to be 78 years—near to the expected life expectancy of the general population.
Mortality in the first year of HIV treatment
A total of 2,106 people died in the first year of starting ART (2% of participants) and 2,302 people (3%) died during the 15,813 person-years included in the study.
People starting HIV treatment in later years (2008 – 2010) were much less likely to die in the first year of treatment than people starting HIV treatment in earlier years (1996 – 2007). The increased availability of more effective and better tolerated HIV medications over time is likely to have contributed to this disparity, the authors said. Mortality in the first year of HIV treatment was “strongly influenced” by people starting treatment very late in their HIV infection (who are already severely immunocompromised).
Mortality in the second and third years of HIV treatment
There were dramatic declines in mortality rate in the second and third years of HIV treatment over time from 1996 to 2010. These declines were consistent across North America and Europe, different age groups, and different CD4 cell counts when ART was started. However, people who inject drugs had higher mortality rates than other people.
“Improvements in survival during the second and third years of ART are probably caused by increased viral suppression, declining rates of viral failure, and increasing treatment options,” the authors said. “Simpler regimens might have contributed to improvements in both short-term and long-term adherence to ART.”
Comorbidities and healthy aging
Because modern-day HIV medications are highly effective and well-tolerated, interventions that improve the life expectancies of people living with HIV will need to address other health conditions that may affect people living with HIV at a disproportionate rate or more severely.
Improving the health of people growing older with HIV is a critical priority, said Harris, Rabkin and El-Sadr, in an editorial published in AIDS. Older adults living with HIV may experience more severe side effects of antiretroviral medications, higher risk of kidney disease, declines in bone mineral density, peripheral neuropathy and cardiovascular disease. An estimated 6.9 million people living with HIV will be over age 50 by the year 2020.
“The ‘greying of the epidemic’ raises important questions regarding understanding the effect of aging on people living with HIV, the effect of HIV infection on the aging process, and optimal approaches to HIV prevention among older adults,” said Harris and colleagues.
The Antiretroviral Therapy Cohort Collection. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. The Lancet HIV, 2017.
Harris, T. G., Rabkin, M. and El-Sadrr, W. M. Achieving the fourth 90: healthy aging for people living with HIV. AIDS, 2018.