Research published in this month’s paper Lancet HIV It claims to have produced one of the most in-depth analyzes of life expectancy for people living with HIV in high-income countries in the modern treatment era. They found that people with high CD4 cell counts who were on antiretroviral therapy (ART) had a life expectancy only a few years lower than the general population, regardless of when they started treatment.
Those who started treatment after 2015 have a slightly longer life expectancy than those who started ART before 2015. However, CD4 cell count and age have the strongest impact on life expectancy, and those with very low CD4 counts (<50) are estimated to live longer. Those with high CD4 counts (>500) have about 20 years less left. “Our results suggest the continued importance of early and sustained ART,” the authors argue.
Life expectancy for people living with HIV has improved dramatically since the introduction of effective antiretroviral therapy, and many studies show that life expectancy for people living with HIV is near-normal or normal compared to the general population. has been reported to be However, all these studies are based on limited data from the first few years of treatment. This is a question of how people who have been on ART for many years compare their life expectancy to that of the general population, and whether long-term HIV infection may shorten life expectancy despite successful treatment​. does not help to understand
To answer this question, Dr. Adam Tricky of the University of Bristol assembled an international research team to examine data from 20 cohort studies of people living with HIV in North America and Europe. The study was limited to people over the age of 16 at the start of treatment, thus excluding most people who were infected with HIV as children. One group of participants had started ART between 1996 and 2014 and was still alive and receiving treatment in 2015, when follow-up data began to be collected. Another group of participants started ART between 2015 and 2019 and survived for at least 1 year thereafter, at which point follow-up data began to be collected. The 2015 cutoff was chosen because treatment guidelines changed to recommend treatment for all people diagnosed with HIV, regardless of CD4 count.
A total of 206,891 HIV-infected people were included in the analysis, and 5,780 deaths were recorded since 2015. Those who started ART after 2015 tended to be younger, had lower CD4 counts, and had higher viral loads at the start of follow-up than those who started ART before 2015. This is most likely because the first group of people had already received treatment. for some time (median 7.8 years) until follow-up began in 2015. In contrast, among those who started ART before 2015, a higher proportion of those diagnosed with AIDS were exposed to older treatments with more side effects.
Risk factor
There were various factors that the authors expected to influence life expectancy, including:
- Year
- sex
- Year treatment started
- How someone got HIV (especially if they got HIV from injecting drug use)
- CD4 and CD8 will be counted after 1 year of treatment and/or at the start of follow-up.
- Lowest CD4 and highest CD8 counts before starting treatment (between treatment start and 2015, if treatment started before)
- Viral load at start of follow-up and 1 year after start of treatment
- Have AIDS or hepatitis C at the start of follow-up
- – Prior exposure to ART medications (zidovudine (AZT), didanosine (ddI), zalcitabine (ddC) or stavudine (d4T)) with increased side effects, or monotherapy and combination therapy.
After adjusting for differences in these factors between participants, the authors found that the greatest risk factor for death was at the start of follow-up (2015, or 1 year after starting treatment for patients who started treatment after 2015). later either) was found to be the CD4 count. The higher the CD4 count, the lower the risk of death. A person with a CD4 count below her 50 has almost five times the risk of death (he is 372% more likely) than someone with a CD4 count above her 500. CD4 counts between 200 and 349 almost doubled the risk of death (92% higher probability).
Unsurprisingly, age also had a significant impact on life expectancy. People aged 60 to 69 were about three times more likely to die (219% more likely) than people aged 30 to 39, and people over 70 were almost eight times more likely to die (666% more likely). rice field. Women had a slightly lower risk of death than men (23% lower than her odds).
Compared with men who contracted HIV through sexual intercourse with other men, men who contracted HIV through drug injection had a nearly 2.5-fold higher risk of death (148% higher probability). This is probably due to sociodemographic factors and the health risks associated with injecting drugs. In contrast, the risk of death for those who contracted her HIV through heterosexual sex was only marginally higher than for men who had sex with men (his odds were 24% higher).
When treatment is started does affect life expectancy, but not as much as other factors. People who started treatment between 1996 and 1999 were 30% more likely to die than those who started treatment between 2015 and 2019. This risk was slightly reduced for those who started treatment later in life, with a 21% higher chance of dying for those who started ART between 2000 and 2004, and those who started between 2005 and 2009 and 2010 and 2014. Both odds were 18% higher. .
Other high-risk factors include viral load >50 copies/ml at start of follow-up (30% more likely to die than those with viral load <50 copies/ml), hepatitis C (38% high) included. more likely than those without hepatitis C), AIDS (60% more likely than those without AIDS).
Interestingly, factors measured before follow-up, such as participants’ lowest CD4 counts and previous exposure to ART drugs with increased side effects, did affect life expectancy, but expected It didn’t affect me as much. People with a minimum CD4 count of 200 to 349 before follow-up had a 5% higher chance of dying compared with those with a minimum CD4 count of >500 before follow-up, compared with those with a minimum CD4 count of 500 those with a BV of less than 50 were 5% more likely to die. 17% more likely to die. Similarly, the risk of death for patients exposed to ART with increased side effects was only 18% increased compared to those who did not receive these treatments, compared with those who received monotherapy or combination therapy. There was only a 3% increase in risk.
life expectancy calculator
The authors then calculated participants’ life expectancy based on whether they started ART before or after 2015, route of HIV infection, viral load at start of follow-up, AIDS status, and CD4 count. .
For those who started treatment before 2015, life expectancy for people now 40 years old was 76 for women and 75 for men, compared with 86 and 81 for the general population, respectively.
“The results of this study provide insight for people who started treatment before 2015 and have been on treatment for many years.”
However, there was a considerable range of estimates depending on the factors outlined above. For example, a 40-year-old woman with a CD4 count less than 50 at the start of follow-up who started treatment before 2015 can be expected to live to age 59, and a similarly situated man can be expected to live to age 58. Expectations improved as CD4 counts increased, so a 40-year-old woman who started treatment before 2015 and had a CD4 count between 200 and 349 at the start of follow-up could be expected to live to age 74 and is in the same situation. Men can expect to live to 74. Women who started treatment before 2015 and had a CD4 count >500 at the start of follow-up are expected to live to an average age of 80 years, while men in the same situation are expected to live to age 78 years. She was virally suppressed, was not diagnosed with AIDS at the start of her follow-up, and was not infected with HIV from injecting drug use, increasing her life expectancy to 82 years. A man in the same situation would be expected to live to 79.
For those who started treatment after 2015, life expectancy for people now 40 was 79 for women and 77 for men. If her CD4 count was less than her 50 at the start of follow-up, this was reduced to 65 years and his to 64 years, respectively. With a CD4 count of 200-349, the life expectancy is similar to the average, calculated at 78 and he at 77, respectively. On the other hand, if the CD4 count is above 500, life expectancy increased to 82 years and he to 79 years respectively. In addition to a CD4 count greater than 500, viral suppression, no AIDS diagnosis at the start of follow-up, and no HIV infection due to injecting drug use, a 40-year-old woman: can be expected. A 40-year-old man is expected to live to 80, with a person expected to live to 83.
Life expectancy also depends on a person’s age. A 20-year-old woman is expected to live to age 72 if treatment is started before 2015 and to age 77 if treatment is started after 2015. A 20-year-old man is expected to live to 71 or 75, respectively.
For both men and women, those who acquired HIV through injecting drug use and who had AIDS at the start of follow-up had the shortest life expectancy.
Conclusion
The results of this study provide insight for people who started treatment before 2015 and have been on treatment for many years. Life expectancy was slightly longer for those who started treatment after 2015, but the difference narrowed when limited to those with high CD4 counts at the start of follow-up. Factors associated with previous HIV infection, such as previous ART use with greater side effects and lower CD4 levels before treatment initiation, also slightly reduced life expectancy estimates, but ultimately were the most influential factors. were age and CD4 levels. Initiate follow-up.
The authors point out that their study offers no indication of health status in later years. A previous study found that a person with HIV was more likely to develop major illness 16 years earlier than a person without HIV, on average. We also could not include other factors that affect life expectancy for everyone, whether they are living with HIV or not, such as social and economic status and lifestyle factors such as whether they are smokers. .