Life Expectancy With HIV Nears That of Uninfected Peers

Norra MacReady

November 14, 2016

With optimal care, the life expectancy of individuals with HIV can approach that of uninfected people, the authors of a new analysis report.

"For the many persons with HIV infection who have access to care, the main barriers to a long and healthy life are lifestyle factors not directly related to this infection," Nicolai Lohse, MD, PhD, DMSc, and Niels Obel, MD, DMSc, write in a letter published in the November 15 issue of the Annals of Internal Medicine.

The findings come from an update of an analysis the authors conducted in 2007, which showed that people 25 years of age who were infected with HIV and not coinfected with hepatitis C virus (HCV) had a median survival age of 63.9 years. Although those data were "encouraging," life expectancy was still 12.2 years less than for a sample of the general population matched for age and sex.

For the new analysis, the authors, both from Copenhagen University, Denmark, estimated changes in median survival over the course of 5 periods: 1995 to 1996, 1997 to 1999, 2000 to 2004, 2005 to 2009, and 2010 to 2015. The study included all HIV-infected people in Denmark, excluding the 9.7% of patients who were also infected with HCV. Each patient was matched with five age- and sex-matched control participants from the general population.

The analysis included 5701 people with HIV and 28,505 controls, for a total of 60,270 person-years of observation for the patients and 365,713 person-years for the control participants. "The study comprised 77% men at a median age at study entry of 37.1 years (interquartile range, 30.5 to 45.5 years)," the authors write.

In the 1995 to 1996 interval, the estimated median age at death for a 25-year-old infected with HIV was 34.5 years (95% confidence interval [CI], 32.3 - 35.9). From 1997 to 1999, that rose to 52.2 years (95% CI, 49.0 - 57.5); in 2000 to 2004, it rose to 62.8 years (95% CI, 60.4 - 64.9); in 2005 to 2009, it rose to 66.8 years (95% CI, 65.7 - 68.5); and in 2010 to 2015, it rose to 73.9 years (95% CI, 72.2 - 76.7). The authors compared these estimates with a median life expectancy of 80.0 years (95% CI, 79.4 - 80.8) among the general population.

People in many parts of the world still cannot obtain the benefits afforded by the most up-to-date therapies, the authors conclude. Addressing these barriers to care is important "because this report and others like it document the benefits we can expect with a strong focus on timely diagnosis, integrated solutions, and new therapies."

Dr Obel reports unconditional research grants from Gilead, GlaxoSmithKline, Jansen, Bristol Myers Squibb, and Boehringer Ingelheim paid to his institution. Dr Lohse has disclosed no relevant financial relationships.

Ann Intern Med. 2016;165:749-750. Abstract

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