In a cohort study of 39,000 adults with HIV infection and 387,785 adults without HIV infection in the U.S., infected individuals lived 6.8 fewer years overall and 9.5 fewer years without major chronic comorbidities, even when antiretroviral therapy was begun at high CD4 cell counts.
Julia Marcus, MD, of Harvard Pilgrim Health Care Institute, originally reported the findings at the 2020 virtual Conference on Retroviruses and Opportunistic Infections (CROI). In this exclusive MedPage Today video, Marcus discusses the study results, which were also published in revised form on Monday, June 15, in JAMA Network Open.
Following is a transcript of her remarks:
We know that antiretroviral therapy has dramatically increased life expectancy for people with HIV over the past several decades. We at Kaiser Permanente had looked at the data up through 2011 several years ago, and found that there had been this dramatic increase in life expectancy, but that people with HIV hadn’t yet reached the same life expectancy as people without HIV. There was a 13 year gap in life expectancy by HIV status. And for people who initiated antiretroviral therapy early, that narrowed to a nine year gap. So what we don’t know now is whether that gap has narrowed further in recent years. And we also don’t know how many of those years that people are living are healthy, meaning lived without major chronic co-morbidities. So our objective for this study was to try to answer those questions about overall lifespan by HIV status, and also the number of healthy years lived by people with and without HIV.
And for this study, we included three Kaiser Permanente regions, Kaiser Northern California, Southern California, and mid-Atlantic States, which cover about 9.5 million people total. We had 39,000 people with HIV that were matched to similar people without HIV in a one to 10 reach ratio. So there were about 390,000 people without HIV in the study. Most for men who have sex with men, which reflects the epidemiology of the epidemic in the U.S. And what we ended up finding was that life expectancy has continued to improve for people with HIV who have access to care. These are all people in an insurance setting. And it has not quite reached that of people without HIV, but it’s close. So for people overall with HIV, there was about a nine year gap in the most recent years in life expectancy. And for those who had initiated antiretroviral therapy early with high CD4 counts above 500, that gap narrowed to 6.8 years. So a very similar lifespan.
On the other hand, we saw a substantial gap in the number of healthy years lived without major chronic co-morbidities, with people with HIV living 16 fewer healthy years than people without HIV. The good news was that gap was narrower, if people with HIV started antiretroviral therapy early with high CD4 counts. And that gap was improving over time for some but not all with co-morbidities.
So the take home message here is there’s good news that people with HIV are nearing the same lifespan as people without HIV, especially if they start antiretroviral therapy early. And the same is true in terms of the number of healthy years lived. So this shows us that what we really need to be doing is widespread HIV testing to facilitate earlier HIV diagnosis so that people are getting on antiretroviral therapy as early as possible to maximize lifespan and overall quality of life.
Source: MedicalNewsToday.com
