concentrating on the future as a theme in this, the last-ever HIV treatment update. So it seems appropriate
to have an update on exactly how much future we might have as individuals.
last piece in HTU about life
expectancy was written in 2010, in How long have I
got, doc? (HTU
This reported that researchers in France
and the Netherlands
had found that some groups of people with HIV now had normal lifespans.
then, a number of studies have confirmed that life expectancy in people with
HIV is continuing to catch up with that of the general population.
study published only a few weeks ago1 looked at increases in life
expectancy in the US.
In our 2010 article, we reported that life expectancy in the population with
HIV was fully 21 years lower than in the general US population, due to racial
and socioeconomic inequality.
recent study finds that now, at the age of 30,2 US men can expect
to live another 47 years and women another 51 – in other words, expect to die
on average at the ages of 77 and 81. (It always has to be stated what age the
life expectancy is from, as you get a
bonus simply by not having died.)
same study found that in 1997, average life expectancy, even of those taking
combination antiretroviral therapy, was only 21 years at age 26: so they could
expect, on average, to die at age 47. By 2012 the life expectancy deficit had
narrowed and people with HIV could, at age 35, have an expected lifespan of 63
is clearly still well short of the national average: but we are not comparing
like with like. People with HIV are more likely to be male, more likely to be
black (US black men die five years sooner than white men) and more likely to
have higher rates of a number of life-shortening attributes ranging from
smoking to suicide. If you compare like with like, the expected lifespan of
HIV-negative people at age 35 in the US with the same demographic
factors is only 72 years.
a nine-year age gap, though. What makes the biggest difference, however, is
late testing. The surplus mortality seen in people with HIV is overwhelmingly
concentrated into the first year after testing, when many may have a low CD4
count. The earlier people with HIV test, the higher our life expectancy will rise.
study found that expected lifespan in people with a current CD4 count under 200
was 66 but in people with a CD4 count above 500 it was 73, or one year above
the comparator HIV-negative group.
expectancy for people with HIV in the UK is generally higher than this –
and seems to be continuing to improve.
average general-population expected lifespan at age 35 in the UK is 80.1 in men and 88.6 in
women. In 2011, average life expectancy in the UK-CHIC cohort, a group
of over half the people with HIV in the UK, was 75 if they had started ART at a
CD4 count above 200 cells/mm3.3 But it was only 58 in
people who started therapy with a CD4 count under 100 cells/mm3 –
such is the death toll due to AIDS in the first months after diagnosis that
those 100 fewer CD4 cells take 17 years off life.
UK-CHIC study, done a year later,4 found that an HIV-positive man aged
35, with a CD4 count between 350 and 500, now had an average expected lifespan
of 77 years; if his CD4 count was over 500, it rose to 81 years – statistically
indistinguishable from the general population, and not adjusted for risk factors. There was even a hint, in another
study,5 that people with HIV who survive till age 60 may, in Europe
at least, expect to have longer
lifespans than the general population – though this evidence is as yet only
based on a tiny group of the oldest people with HIV (wait until we’re all
80-year-olds and we’ll find out).
most heartening life expectancy development in the last three years, however, comes
from several studies that show that life expectancies in people with HIV are
starting to become normal even in lower-income countries. A study from Uganda6 found that the
expected average lifespan of a 35-year-old with HIV was now 51 in men and 67.5
in women. This compares to a life expectancy at birth of 53 in men and 55 in women. Life expectancy at age 35
will be higher due to high child mortality rates, but still, these new
projections are approaching equivalence to the general population.