Considerable improvements in survival among patients with HIV have occurred since the introduction of combination antiretroviral therapy (ART) and as these drugs have become more effective, simpler to use, and better tolerated over time. Studies have consistently shown that ART helps increase the lifespan of people with HIV and reduce risks for new infections. “ART has revolutionized how clinicians care for HIV-positive individuals and has had a major effect at both the individual and societal levels,” says Hasina Samji, PhD.

As life expectancy has increased since the introduction of ART, research has shown that more and more people with HIV are experiencing age-related comorbid conditions—as evidenced in the general population—such as cancer. “These comorbidities can impact the length of time people with HIV live as well as their quality of life,” says Robert S. Hogg, PhD. In published analyses, there has been a small but persistent gap with regard to the lifespan of people infected with HIV and those who are uninfected, especially within certain subgroups of patients.

Life-Expectancy-HIV-Callout

About 20 years ago, the estimated life expectancy was 57.0 years for men with HIV and 61.7 years for women with HIV living in the United States. For Canada, the corresponding rates were 59.7 years for men and 63.9 years for women. “While ART has been shown to help increase survival among adults with HIV on a global level, the effect of this therapy on life expectancy in the U.S. and Canada has not been well characterized,” says Dr. Samji. “Furthermore, there is a dearth of studies examining potential differences in life expectancy across sex, race, or transmission groups.”

Longer Longevity

In a study published in PLoS ONE, Dr. Samji, Dr. Hogg, and other investigators examined temporal changes in life expectancy from 2000 to 2007 among patients with HIV in the U.S. and Canada who were taking ART. The study group then compared life expectancy by selected sociodemographic and clinical characteristics. Participants were from the North American AIDS Cohort Collaboration on Research and Design, aged 20 or older, and on ART.

According to the results, life expectancy increased from 36.1 years in 2000-2002 to 51.4 years in 2006-2007. Age-specific mortality rates were highest in the earliest period assessed in the study and lowest in 2006-2007 (Figure). Based on the current patterns of ART use, a 20-year old on ART today in the U.S. or Canada would expect to live into their early 70s, according to Dr. Samji. “This is a life expectancy that approaches that of a 20-year old in the general population today,” she says. “Our findings document an increasing longevity for people with HIV and are a testament to the improvements and overall success of ART.”

Assessing Subgroups

Although patients with HIV are living longer, the study also revealed large differences in life expectancy among certain subgroups of patients. For example, men and women had comparable life expectancies in all periods that were assessed in the analysis except the last. “In general, we expected women with HIV to have a higher life expectancy than men in the general population, but this was not evident in our findings,” says Dr. Samji. “The similar life expectancies by sex and higher life expectancy for men suggest that women may be accessing HIV care at later stages of the disease.” She notes that other potential reasons for this discrepancy may include education, pregnancy, income, social stigma, marginalization, and overall access to the healthcare system.

“Our findings document an increasing longevity for people with HIV and are a testament to the improvements and overall success of ART.” 

Life expectancy was also lower for patients with a history of injection drug use, Caucasians, and those with baseline CD4 counts less than 350 cells/mm(Table). “These life expectancy discrepancies may reflect underlying differences in socioeconomic conditions, access to care, and health insurancecoverage,” says Dr. Hogg. Dr. Samji notes that findings on life expectancy in HIV patients with higher CD4 counts add to the current evidence showingthat earlier treatment is better. “The gaps in lifeexpectancy may be attributable to other lifestyle factors and not just HIV infection,” she adds. “There is a need for strategies and programs to combat these inequities.”

Looking Ahead

According to Dr. Samji, results of the study team’s analysis further support the notion that clinicians have come a long way in managing patients with HIV. “What was once considered a death sentence back when HIV first emerged has now become a chronic but manageable disease,” she says. “In the future, it’s hoped that studies will explore specific
reasons for these life expectancy trends, both overall and within subgroups. These data will have significant public health ramifications and could be vital to targeting priorities for improvements. Future research should also examine quality of life among these subgroups, since the proportion of people aging with HIV continues to grow.”

References

Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE. 2013;8(12):e81355. Available at: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0081355;jsessionid=E0A794BFADBEF68D02568470CD648948.

Losina E, Schackman BR, Sadownik SN, et al. Racial and sex disparities in life expectancy losses among HIV-infected persons in the United States: impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy. Clin Infect Dis. 2009;49:1570-1578.

Lima VD, Hogg RS, Harrigan PR, et al. Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS. 2007;21:685-692.

DHHS: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 2012. Available at: aidsinfo.nih.gov/contentfiles/lvguidelines.