NEW YORK -- August 4, 2008 -- Improvements in and long-term effectiveness of combination antiretroviral therapy (cART) for HIV-infected patients in high income countries have seen life expectancy increase by some 13 years from 1996 to 1999 and from 2003 to 2005, and an accompanying drop in mortality of nearly 40% in the same period, according to an article in the July 26 issue of The Lancet.
However, life expectancy in these patients remains well short of the general population, and patients treated late in the course of their infection have worse life expectancy.
Robert Hogg, British Colombia Centre for Excellence in HIV/AIDS, Vancouver, British Colombia, and Simon Fraser University, Burnaby, British Colombia; and Jonathan Sterne, University of Bristol, Bristol, United Kingdom; and colleagues from The Antiretroviral Therapy Cohort Collaboration (ART-CC) compared changes in mortality and life expectancy among HIV-positive individuals on cART.
This collaboration of 14 studies in Europe and North America analysed 18,587 patients who started cART from 1996 to 1999; 13,914 from 2000 to 2002; and 10,584 patients from 2003 to 2005.
A total of 2,056 patients died during the study period, with mortality decreasing from 16.3 deaths per 1,000 person-years from 1996 to 1999 to 10.0 from 2003 to 2005 -- a drop of around 40%.
Potential life years lost per 1,000 person-years also decreased over the same time, from 366 to 189 -- a fall of 48%. Life expectancy increased from 36.1 years from 1996 to 1999 to 49.4 years from 2003 to 2005, an increase of more than 13 years.
Patients treated later in the course of their infection, with lower CD4 counts (<100 cells per mcL blood at initiation of cART), had shorter life expectancy, at 32.4 years, compared with 50.4 years in patients treated at earlier stages with higher CD4 loads
(>200 cells per mcL).
Patients with presumed transmission via injecting drug use had a shorter life expectancy (32.6 years) than those from other transmission groups (44.7 years).
Finally, women had a slightly longer life expectancy than men (44.2 vs 42.8 years), which may be due to women on average starting their treatment earlier in the course of HIV-infection.
Despite these positive results, an HIV-positive person aged 20 years starting cART will only, on average, live another 43 years (to age 63), while an HIV-negative person aged 20 years in a high-income country can expect to live to around 80 years -- a difference of nearly 20 years. This last finding leads the authors to call on health planners to improve health services and living conditions for HIV-infected patients to reduce this gap.
"The progressive reductions in mortality and gains in life expectancy over the 3 periods studied here are probably the result of both improvements in therapy during the first decade of cART and continuing declines in mortality rates among individuals on such treatment for long periods," the authors wrote.
"… These advances have transformed HIV from being a fatal disease, which was the reality for patients before the advent of combination treatment, into a long-term chronic condition."
"In summary, the results of this study indicate that people living with HIV in high-income countries can expect increasing positive health outcomes on cART. The marked increase in life expectancy since 1996 is a testament to the gradual improvement and overall success of such treatment," the authors concluded.
SOURCE: The Lancet
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