The lifespan of HIV-infected individuals has increased dramatically with combination antiretroviral therapy, yet an 8- to 13-year gap in survival persists when compared to individuals without the virus, according to a Kaiser Permanente study published in JAIDS, the Journal of Acquired Immune Deficiency Syndromes.
The study estimated life expectancy — the average number of years of life remaining — at age 20 in HIV-infected and uninfected individuals from 1996 through 2011. The study cohort included nearly 25,000 HIV-infected adults and over 250,000 adults without the virus who were matched for age, gender, medical center and year. All individuals were members of Kaiser Permanente California, a large integrated healthcare system.
“We observed a steep increase in life expectancy for HIV-infected individuals during the study period,” said lead author Julia Marcus, PhD, MPH, postdoctoral fellow at the Kaiser Permanente Division of Research. “In 1996 to 1997, life expectancy at age 20 for HIV-infected individuals was only 19 years — meaning that an HIV patient was expected to live to age 39. By 2011, an HIV patient could be expected to live to age 73.”
However, a gap in life expectancy persists between HIV-infected and uninfected individuals, ranging from 8 to 13 years depending on when antiretroviral therapy (ART) is initiated, as well as demographics and risk factors.
In the 1996-1997 time period, the gap in life expectancy at age 20 between HIV-infected and HIV-uninfected individuals was 44.3 years. By the 2008-2011 time period, the gap had narrowed to 13.1 years.
The lowest life expectancies at age 20 for HIV patients from 2008 to 2011 were among blacks (45.8 years) and those with a history of injection drug use (46.0 years), and the highest was for Hispanics (52.2 years).
During the same time period, HIV patients who had initiated antiretroviral therapy early, with a CD4 cell count of 500 more, had a life expectancy at age 20 of 54.5 years, corresponding with a gap, relative to HIV-uninfected individuals, of 7.9 years. The gap narrowed further to 5 to 7 years in subgroups without a history of hepatitis B or C infection, drug or alcohol abuse, or smoking.
“Our results highlight the importance of timely ART initiation and risk-reduction strategies, such as smoking cessation, to increase the lifespan of HIV-infected individuals,” said senior author Michael J. Silverberg, PhD, MPH. “Future studies should consider other factors that may contribute to the survival disparity for HIV patients, such as cancer, cardiovascular disease, and other aging-associated conditions.”