Extending Survival for HIV-Infected Patients

Over the past few decades, advances in antiretroviral therapy (ART) have enabled many HIV-infected patients to live longer lives. Despite these successes, substantial avoidable losses in life expectancy of HIV-infected persons persist in the United States. The factors that exert a significant impact on survival include: • Late diagnosis. • Late initiation of care. • Premature discontinuation of therapy. • Background behavioral risk factors, such as alcohol, substance abuse, and smoking, which are prevalent in individuals with HIV. Assessing Survival Losses In the November 15, 2009 issue of Clinical Infectious Diseases, my colleagues and I published a study in which we estimated survival losses related to HIV disease in the U.S. This included 1) behavioral risk factors in the absence of HIV, 2) HIV disease per se, and 3) late initiation and/or early discontinuation of life saving ART. For individuals who were not infected with HIV and had risk profiles similar to those who were infected, we found that the projected life expectancy, starting at age 33, was 34.6 years, compared with 42.9 years for the general U.S. population. These findings suggested that about 8 fewer years, or a 19% reduction, in life expectancy is due to substance abuse and other high-risk behaviors even in the absence of HIV. These losses underscore the critical importance of interventions which focus on reducing substance abuse and other high-risk behaviors. Patients infected with HIV lost an additional 11.9 years of life if they received HIV care that was concordant with guidelines (representing an additional 28% reduction). The estimated life expectancy for HIV-infected patients who initiated ART very late—when CD4 cell counts reached...