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IAS 2013: Life Expectancy of HIV+ People in North America Increased by 15 Years

A 20-year-old HIV positive person on effective antiretroviral therapy (ART) in the U.S. or Canada has a remaining life expectancy of about 50 years, approaching that of HIV negative individuals, according to a poster presented at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) last month in Kuala Lumpur.

It is well known that the advent of effective combination ART led to dramatic reductions in illness and death among people with HIV, but increases in life expectancy have not been fully characterized.

Keri Althoff from Johns Hopkins University and colleagues conducted a study to estimate changes in life expectancy over time among HIV positive adults on ART from in the U.S. and Canada during 2000-2007.

The analysis included 22,937 participants in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) who were age 20 or older when they started ART for the first time. Three-quarters were men, about 40% were white, nearly 40% were men who have sex with men (MSM), and about 20% were injection drug users (IDUs); 72% had CD4 T-cell counts below 350 cells/mm³ at the time of ART initiation. Overall, 25% started treatment at age 20-34, 42% started at age 35-44, 25% started at age 45-54, and 8% started at age 55 or older.

The researchers calculated mortality rates and used abridged life tables to estimate life expectancy at age 20 -- defined as the average number of additional years of life -- assuming current age-specific mortality rates remain constant.

Results

• A total of 1622 deaths were reported during the study period, for an overall crude mortality rate of 19.8 per 1000 person-years.
• Mortality rates differed, however, by race (16.0 for whites, 22.4 for non-whites), HIV transmission group (12.5 for MSM, 34.5 for IDUs, 19.1 for other groups), and baseline CD4 count (23.3 for <350, 11.3 for >350 cells/mm³).
• Overall life expectancy at age 20 increased from 36.1 more years during 2000-2002 to 51.4 more years during 2006-2007, an increase of 15.3 years.
• Men and women had comparable life expectancies in all periods except 2006-2007, during which men were expected to live 6.1 additional years (53.4 vs 47.3 years, respectively).
• Life expectancy was significantly lower for non-white participants, those with a history of injection drug use, and those with baseline CD4 counts below 350 cells/mm³.
• However, all groups except injection drug users saw an increase in life expectancy over time:

o   White: 52.7 years during 2000-2002 to 56.9 years during 2006-2007;

o   Non-white: 29.7 years to 48.4 years, respectively;

o   MSM: 53.5 years to 69.3 years, respectively;

o   IDUs: 29.5 years to 28.8 years, respectively;

o   Other risk group: 43.5 years to 56.1 years, respectively;

o   Baseline CD4 count < 350: 31.4 years to 46.9 years, respectively;

o   Baseline CD4 count > 350: 48.4 years to 68.9 years, respectively.

"A 20-year-old HIV-positive individual on ART in the U.S. or Canada is expected to live into their early 70s, a life expectancy approaching that of the general population," the investigators concluded, acknowledging that differences by sex, race, HIV transmission risk group, and CD4 count continue to exist.

8/7/13

Reference

RS Hogg, KN Althoff, H Samji, et al. Increases in life expectancy among treated HIV-positive individuals in the United States and Canada, 2000-2007. 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013. Abstract TUPE260.