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Life expectancy of people with HIV on antiretroviral therapy in Spain: gap of 8.3 & 13.9 years persists in men & women compared to general population
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March 1 2024
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Jarrin, Inmaa,b; Rava, Martaa,b; Del Romero Raposo, Jorgea; Rivero, Antoniob,c; Del Romero Guerrero, Jorged; De Lagarde, Mariab,e; Martinez Sanz, Javierb,f; Navarro, Gemmag; Dalmau, Davidh; Blanco, José Ramóni; Koerting, Anaj; Gomez Castell, Javierj; Del Amo, Juliaj; CoRIS∗
A gap of 8.3 and 13.9 years in men and women, respectively, compared with the general population persists.
Compared with people who started ART with less than 200 cells/μl CD4+ cell counts, those who started with 200-349 cells/μl (MRR: 0.76; 95% CI: 0.61-0.94), or at least 350 cells/μl (MRR: 0.46; 95% CI: 0.34-0.60) showed lower mortality rates. Starting ART with a prior AIDS diagnosis doubled the mortality rate (MRR: 2.13; 95% CI: 1.77-2.57)......For MSM, aged 40 years who started ART in 2014-2019 with no prior AIDS diagnoses, and a CD4+ cell count over 350 cells/μl, life expectancy was 78.1 years, only 3.1 years lower than the overall life expectancy (81.2 years) in men of the general population in Spain.
The most frequent causes of death nowadays are deaths because of non-AIDS-defining cancers, the most common being lung cancer, death from liver causes, and from non-AIDS infections
Methods:
We calculated life expectancy at age 40 for men and women according to their ART initiation period, and stratified by transmission category, CD4+ cell count and AIDS diagnosis. We estimated life expectancy in 10-year age bands using life tables constructed from mortality rates, estimated through Poisson models.
Results:
Life expectancy increased from 65.8 [95% confidence interval (CI) 65.0-66.6] in 2004-2008 to 72.9 (72.2-73.7) in 2014-2019 in men [general population comparators (GPC): 79.1 and 81.2 years, respectively] and from 65.8 (65.0-66.6) to 72.5 (71.8-73.3) in women (GPC: 84.9 and 86.4, respectively). Non-AIDS-related deaths accounted for 68% of deaths among men and 78% among women. Life expectancy was longer when starting ART with higher CD4+ cell counts and without AIDS. For men acquiring HIV through sex with men, starting ART in 2014-2019 without AIDS, life expectancy was 75.0 (74.2-75.7) with CD4+ cell count less than 200 cells/μl, rising to 78.1 (77.5-78.8) with CD4+ cell count at least 350 cells/μl. Corresponding figures were 70.1 (69.4-70.9) and 76.0 (75.3-76.7) for men acquiring HIV heterosexually (HTX) and 61.5 (60.7-62.3) and 69.0 (68.2-69.8) for those acquiring HIV through injection drug use (IDU). For women starting ART from 2014 without AIDS, life expectancy increased from 71.7 (71.0-72.4) to 77.3 (76.7-77.9) among HTX and from 63.7 (62.9-64.5) to 70.7 (70.0-71.5) among IDU.
Conclusion:
Our findings confirm the progressive improvement of life expectancy in PWH in Spain over the last decades, supporting the insurability of PWH on suppressive ART in our current setting and time
Supplemental Table 2: Estimated age at death (95%CI) for men and women aged 40 years at starting ART, stratified by period of ART initiation
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