Thanks to modern antiretroviral therapy, the life expectancy average of HIV-infected people has improved significantly. It is now only 3.3 years less than that of non-infected persons. However, many of them suffer from comorbidities, according to the results of a cohort study presented by Julia Marcus, Harvard Medical School, Boston (USA), at the virtual CROI in March 2020.
Antiretroviral therapy (ART) has dramatically improved the life expectancy of HIV-infected people. The gap between sick and healthy people in the years 2008 to 2011 was 13 years and 9 years for HIV-infected people who started antiretroviral therapy at CD4 cell counts ≥ 500.
Because current data on life expectancy and comorbidities were lacking, Marcus and her team analyzed life expectancy and years of life without comorbidities in people with and without HIV in a USA-focused cohort study. The data were taken from the Kaiser-Permanente database. Three regions were considered, namely Northern California with 4.4 million, Southern California with 4.6 million and the Mid-Atlantic states with 750,000 persons.
The cohort study included data from adults aged 21 years and older with and without HIV infection from 2000 to 2016. HIV-infected people were matched 1:10 with non-infected persons according to age, sex, ethnic origin, medical center and year. Clinical data were obtained from electronic medical reports and internal registers. Additional mortality data was taken from death certificates and pension insurance data. The following comorbidities were examined more closely: Chronic liver, kidney and lung disease, diabetes mellitus, cancer, and cardiovascular disease.
The cohort consisted of 39,000 HIV-infected persons and 387,767 matched control persons in the middle age of 41 years. 88% were male, 45% were white, 25% black. 70% of HIV-infected persons were men who had sex with men (MSM), 20% were heterosexuals. 18% had previously received ART, and 64% initiated ART during follow-up. 29% of the test people had a CD4 cell count above 500 at the start of ART.
The additional life expectancy for a 21-year-old person increased in the control subjects from the period 2000 to 2003 at 60 years to 65 years in the period 2014 to 2016. Among HIV-infected people, life expectancy increased during these periods from 38 to 56 years, so according to these data, an HIV-infected person at 21 can reach 77 years of age. The gap between the two groups thus narrowed from 22 to 9 years. For HIV-infected persons who start ART early, the gap in life expectancy decreased to 3.4 years.
The additional years of life without concomitant diseases increased from 27 to 31 years in the control group, so according to these calculations, a 21-year-old patient lives until the age of 52 without comorbidities. In HIV-infected persons at the age of 21 years, the additional years without comorbidities increased from 11 to 15. Antiretroviral therapy had no effect.
For liver, kidney and lung diseases, a large gap in the disease-free years between HIV-negative and HIV-positive patients was observed, which did not decrease over time. In contrast, the curves of the comorbidity-free years for diabetes, cancer and cardiovascular diseases converged over the time periods studied.
For HIV-infected people who started ART with a CD4 cell count above 500, the co-morbidity-free life expectancy improved for cancer and cardiovascular diseases, but not for liver, kidney and lung diseases.
The results thus show that life expectancy has continued to increase in HIV-infected patients, especially with ART. However, HIV-infected persons experience significantly fewer years without comorbidities, and ART has no influence on this. Marcus concluded therefore that "more attention must be paid to the prevention of comorbidities in HIV-infected persons”.
Marcus J, et al. Increased overall life expectancy but not comorbidity-free years for people with HIV. Virtual CROI 2020, Abstract 151. https://www.croiconference.org/sessions/increased-overall-life-expectancy-not-comorbidity-free-years-people-hiv