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Life Expectancy reduced 20 years If ART Started at < 350 CD4s - Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United States and Canada
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PLOS ONE 2013 - Hasina Samji1, Angela Cescon1, Robert S. Hogg1,2*, Sharada P. Modur3, Keri N. Althoff3, Kate Buchacz4, Ann N. Burchell5, Mardge Cohen6, Kelly A. Gebo3, M. John Gill7, Amy Justice8, Gregory Kirk3, Marina B. Klein9, P. Todd Korthuis10, Jeff Martin11, Sonia Napravnik12, Sean B. Rourke5, Timothy R. Sterling13, Michael J. Silverberg14, Stephen Deeks 15, Lisa P. Jacobson3, Ronald J. Bosch16, Mari M. Kitahata17, James J. Goedert18, Richard Moore3, Stephen J. Gange3, for The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA"
Study finds life expectancy of 71.4 years in HIV+ HOWEVER starting HAART at CD4 below 350 CD4 reduced life expectancy by 20 years. What about 100 nadir CD4 the study does not report on this. Study also found big gaps in life expectancy for whites vs non-Whites, for women vs men, and for IDUs vs all others. What about comorbidities? How will multicormorbidities & polypharmacy & frailty impact lifespan? from Jules
In conclusion, the results of this study document increasing longevity for individuals living with HIV in the U.S. and Canada. The marked increase in life expectancy at age 20 from 36.1 years in 2000-2002 to 51.4 years in 2006-2007 is a testament to the improvements and overall success of ART. However, large differences in life expectancy persist between certain sub-groups of patients. Future work should consider specific reasons for these life expectancy gains, overall and within each sub-group. These data will be vital to target priorities for improvements in health services. Finally, in addition to quantity, future work should consider quality of life, as the proportion of individuals aging with HIV continues to grow.
Abstract
Background
Combination antiretroviral therapy (ART) has significantly increased survival among HIV-positive adults in the United States (U.S.) and Canada, but gains in life expectancy for this region have not been well characterized. We aim to estimate temporal changes in life expectancy among HIV-positive adults on ART from 2000-2007 in the U.S. and Canada.
Methods
Participants were from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), aged ≥20 years and on ART. Mortality rates were calculated using participants' person-time from January 1, 2000 or ART initiation until death, loss to follow-up, or administrative censoring December 31, 2007. Life expectancy at age 20, defined as the average number of additional years that a person of a specific age will live, provided the current age-specific mortality rates remain constant, was estimated using abridged life tables.
Results
The crude mortality rate was 19.8/1,000 person-years, among 22,937 individuals contributing 82,022 person-years and 1,622 deaths. Life expectancy increased from 36.1 [standard error (SE) 0.5] to 51.4 [SE 0.5] years from 2000-2002 to 2006-2007. Men and women had comparable life expectancies in all periods except the last (2006-2007). Life expectancy was lower for individuals with a history of injection drug use, non-whites, and in patients with baseline CD4 counts <350 cells/mm3.
OF NOTE you can see with CD4 <350 at start of ART life expectancy is 21years less, with a life expectancy of 78.6 years if ART started at >350 CD4s and 66.9 years if ART was started with CD4 at less than 350.
Conclusions
A 20-year-old HIV-positive adult on ART in the U.S. or Canada is expected to live into their early 70 s, a life expectancy approaching that of the general population. Differences by sex, race, HIV transmission risk group, and CD4 count remain.
Figure 2. Mid-point life expectancy estimates at age 20 years in three calendar periods, overall and by sociodemographic
characteristics, 2000-2007.
Panel A: Life expectancy at age 20 years, overall. Panel B: Life expectancy at age 20 years, by sex. Panel C: Life expectancy at age 20 years, by transmission group. Panel D: Life expectancy at age 20 years, by race. Panel E: Life expectancy at age 20 years, by CD4 cell count (cells/mm3) at ART initiation.
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