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Life Expectancy With HIV Still Low in High-Income Countries
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Mark Mascolini
February 27, 2007
14th Conference on Retroviruses and Opportunistic Infections
Los Angeles
Though many assume potent antiretroviral therapy (ART) turned HIV infection into an easily managed chronic disease, a new analysis of 16 cohorts in Europe and North America found that people starting treatment can expect to live only half as long as people without HIV infection [1]. ART Cohort Collaboration researchers figured that life expectancy of a 20-year-old starting treatment stops short at 58 years.
Robert Hogg (University of British Columbia) and colleagues based their analysis on more than 26,000 ART-naive people starting their first regimen in three periods-14,993 people starting from 1996 through 1999, 9385 from 2000 through 2002, and 3614 from 2003 through 2005. Everyone remained on treatment for at least 1 year. Hogg reckoned age-standardized mortality rates for all-cause mortality, life expectancy from exactly 20 years of age, and life expectancy stratified by gender, history of injecting drug use, and CD4 count upon entering the cohort.
Mortality per 1000 people fell over each treatment period, from 45.1 in 1996-1999, to 31.5 in 2000-2002, down to 27.8 in 2003-2005. Those rates proved lower in 20- to 44-year-olds: 35.7 in 1996-1999, 25.6 in 2000-2003, and 12.7 in 2003-2005. But 20-year-olds in the 1996-1999 cohort could expect to live only another 24.3 years, while those in the 2000-2002 group could look forward to only another 27.1 years of life, and those in the 2003-2005 group could count on only another 33.2 years. Percentages of 20-year-olds who could anticipate living to 44 stood at only 43.8% in 1996-1999, 54.1% in 2000-2002, and 78.6% in 2003-2005.
Reversing trends in the population at large, 20-year-old HIV-infected men could expect to live slightly longer than women--33.5 versus 33.0 years--if they started ART in 2003-2005. Twenty-year-old injecting drug users, on the other hand, could look forward to only another 28.2 years of life if they began treatment in that period versus 34.7 years among non-drug users.
Not surprisingly, life expectancy in the 2003-2005 group rose with each higher CD4-cell bracket at cohort entry: 30.9 years for people with fewer than 200 cells, 33.8 years for those with 200 to 349 cells, and 38.3 years for those with 350 or more cells. But 20-year-olds with an entry CD4 count at or above 350 had blunted life expectancies, according to this analysis: Only 76.4% in the 1996-1999 cohort could expect to see their 44th birthday, compared with 75.2% in the 2000-2002 cohort, and 89.6% in the 2003-2005 cohort.
Hogg and ART Cohort Collaboration coworkers "encourage health planners to use these data to improve health services and living conditions for people living with HIV."
Reference
1. Hogg R and ART Cohort Collaboration. Life expectancy of persons at the time of initiating cART in high-income countries. 14th Conference on Retroviruses and Opportunistic Infections. February 25-28, 2007. Los Angeles. Abstract 972.
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