We’re 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.
The last piece in HTU about life expectancy was written in 2010, in How long have I got, doc? (HTU 195). This reported that researchers in France and the Netherlands had found that some groups of people with HIV now had normal lifespans.
Since 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.
One 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.
This 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.)
The 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 years.
This 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.
Still 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.
This US 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.
Life expectancy for people with HIV in the UK is generally higher than this – and seems to be continuing to improve.
The 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.
A 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).
The 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.
- Farnham PG et al. Lifetime costs and quality-adjusted life years saved from HIV prevention in the test and treat era. JAIDS 64(2): early online edition, 1 October 2013.
- US Social Security actuarial tables: see www.ssa.gov/oact/NOTES/as120/LifeTables_Tbl_10.html#wp1041324
- May M et al. Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) study. BMJ 343, 2011.
- May M et al. Life expectancy of HIV-1-positive individuals approaches normal, conditional on response to antiretroviral therapy: UK collaborative HIV cohort study. Eleventh International Congress on Drug Therapy in HIV Infection, Glasgow, abstract O133, 2012.
- Sabin C Review of life expectancy in people with HIV in settings with optimal ART access: what we know and what we don’t. Eleventh International Congress on Drug Therapy in HIV Infection, Glasgow, abstract O131, 2012.
- Mills EJ Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Intern Med. 155, 4, 2011.