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HIV Life Expectancy Jumps 34 Years in Switzerland But Lags General Population
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21st International AIDS Conference (AIDS 2016), July 18-22, 2016, Durban, South Africa
Mark Mascolini
Life expectancy with HIV at age 20 jumped from 20.8 years in 1992-1995 to 54.9 years in 2006-2013 [1]. But in the most recent period life expectancy in the most-educated HIV-positive people matched that of only the least-educated people in the general population.
Research in many countries confirms greater life expectancy in people with more education, noted Swiss HIV Cohort Study (SHCS) researchers who conducted this study. They set out to determine whether education also affects survival in people with HIV and to compare life expectancy in people with HIV and in the general population.
The researchers included all HIV-positive people 20 years old or older in the SHCS from 1992 to 2013. The SHCS is a nationwide prospective cohort study of HIV-positive people. The investigators defined four antiretroviral treatment eras: dual therapy (1992-1995), early combination antiretroviral therapy (cART) (1996-1998), later cART (1999-2005), and recent cART (2006-2013). They used parametric survival regression models to assess remaining life expectancy at age 20. For every HIV-positive person, the researchers randomly selected up to 100 people from the Swiss National Cohort, matching the groups by year of birth, sex, and education level (compulsory education only, vocational training, and higher education).
The analysis involved 16,532 people with HIV (72% of them men) and 1,328,985 matched individuals in the general population. Two thirds of the HIV group had not taken antiretrovirals at enrollment in the SHCS, and 28.5% currently or formerly injected drugs. Over the 1992-2013 study period, the proportion of SHCS members who injected drugs fell and the proportion with higher education rose (from just over 10% to just over 30%). Compared with people who had only compulsory education, those with higher education were more likely to be men who have sex with men (MSM) and less likely to be smokers or drug injectors.
Among people with HIV infection, life expectancy at age 20 rose from 20.8 years in 1992-1995, to 44.7 years in 1996-1998, to 50.8 years in 1999-2005, and to 54.9 years in 2006-2013. Life expectancy with HIV improved most in the group with higher education (from 26.7 years in 1992-1995 to 60.0 years in 2006-2013), while improving less in people with vocational training (from 25.3 years in 1992-1995 to 52.6 years in 2006-2013) and in people with only compulsory education (from 24.3 years in 1992-1995 to 52.7 years in 2006-2013).
Among MSM life expectancy at age 20 climbed from 22.9 years in 1992-1995 to 56.8 years in 2006-2013. Life expectancy in people infected with HIV heterosexually was 29.6 years in 1992-1995 and 56.7 years in 2006-2013, and in people infected while injecting drugs 15.7 years in 1992-1995 and 35.8 years in 2006-2013. In 2006-2013, life expectancy at age 20 in people with HIV who never smoked was 59.0 years, compared with 54.6 years in former smokers, and 49.4 years in current smokers. The researchers noted that "in the recent cART era, HIV-positive individuals may lose more life years through smoking than through their HIV infection."
The 60.0-year life expectancy with HIV and higher education in 2006-2013 nearly matched the 61.2-year life expectancy in the general population with only compulsory education and substantially lagged the 65.3-year life expectancy in the general population with higher education.
A recent 282,000-person comparison of people with versus without HIV in the US Kaiser Permanente healthcare system found that the difference in life expectancy narrowed from 44 years in 1996-1997 to 12 years in 2011 [2]. But the gap persisted in 2011 even among people who started antiretroviral therapy at a CD4 count above 500. In a nationwide study of HIV-positive people in Denmark, survival at age 50 doubled from 11.8 years in 1996-1999 to 22.8 years in 2006-2014 [3]. But people with HIV still had a shorter life expectancy than people the same age and gender in the general population.
References
1. Gueler A, Zwahlen M, Calmy A, et al. Getting there? Life expectancy by HIV status and education in Switzerland. 21st International AIDS Conference (AIDS 2016). July 18-22, 2016. Durban, South Africa. Abstract TUPEB031.
2. Marcus JL, Chao C, Leyden W, et al. Narrowing the gap in life expectancy for HIV+ compared with HIV- individuals. Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston. Abstract 54. http://www.natap.org/2016/CROI/croi_25.htm
3. Legarth RA, Ahlstrom MG, Kronborg G, et al. Long-term mortality in HIV-infected individuals 50 years or older: a nationwide, population-based cohort study. J Acquir Immune Defic Syndr. 2016;71:213-218.
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