Improved HIV care has increased life expectancy by up to ten years

Advances in antiretroviral drugs and other improvements in HIV services mean that a young person diagnosed with HIV today and treated promptly would expect to have a near-normal life expectancy, study results published in The Lancet HIV
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Using data from Europe and North America on people diagnosed with HIV who started antiretroviral treatment with three or more drugs between 1996 and 2010, researchers from the University of Bristol found that a 20-year-old man who started antiretroviral therapy in 2010 would be projected to live ten years longer than one who started treatment in 1996. A 20-year-old woman would live for an additional nine years.

Data on 88,504 people with HIV who had been involved in 18 studies were included in the analysis, which showed that fewer people who started antiretroviral treatment between 2008 and 2010 died during this period compared with those who began treatment between 1996 and 2007. Life expectancy predictions were calculated based on death rates during the first three years of follow up after drug treatment was started.

Patients starting antiretroviral therapy in 2008–2010 had lower all-cause mortality in the first year after ART initiation than patients starting ART in 2000–2003 (adjusted hazard ratio [HR] 0·71; 95% confidence interval [CI] 0·61–0·83), and their all-cause mortality in the second and third years was also lower (adjusted HR 0·57, 95% CI 0·49–0·67). This decrease was not fully explained by changes in viral load and CD4 cell count at one year, and rates of non-AIDS deaths were also lower in patients who started antiretroviral therapy in 2008–2010 compared with those initiated in 2000–2003.

The researchers conclude that the improvement in survival seen within the first three years of ART “probably reflects transition to less toxic antiretroviral drugs, improved adherence, prophylactic measures, and management of comorbidity”. They calculate that the expected age at death of a 20-year-old patient starting antiretroviral therapy between 2008 and 2010, who had a CD4 count of more than 350 cells per μL one year after starting treatment, to be 78.0 years (95% CI 77·7–78·3).

Laura Waters, lead consultant physician for HIV and hepatitis at the Mortimer Market Centre for sexual health, Central and North West London NHS Foundation Trust, says the improvements in life expectancy were the result of more effective drugs with fewer side effects, earlier treatment and high quality care from HIV services.

“Our services need to prepare and adapt to manage an ageing HIV population and work together with colleagues in primary care and other services to provide effective care. Also, more than one in eight people with HIV do not know they have it, so to ensure everyone with HIV can enjoy the benefits of treatment, we must work hard to improve testing and ensure the new NICE guidelines for HIV testing are implemented across England,” she adds.

Commenting on the results, Heather Leake Date, a consultant pharmacist in HIV/sexual health at Brighton and Sussex University Hospitals NHS Trust, and a spokesperson for the HIV Pharmacy Association, says: “These encouraging results reinforce our clinical experience in the UK, that early diagnosis of HIV and prompt ART initiation, coupled with high levels of retention in care and adherence to ART, are driving improvements in life expectancy.

“Effective multidisciplinary team working and partnership with patients have been instrumental in achieving these positive outcomes; it’s vital these continue as we address the ongoing challenges associated with an ageing cohort with increasing multimorbidity and polypharmacy,” she adds.