In recent years, 178% increase in life expectancy for people living with HIV
In recent years, life expectancies for people living with HIV have jumped up dramatically with increased access to ever more-effective antiretroviral therapy (ART). A new study, of people receiving care from the Kaiser Permanente health system in California, has found that between 1996/1997 and 2011, the life expectancy of people living with HIV after age 20 has increased by 178%—from 19.1 years to 53.1 years.
“These findings confirm that ART has had a substantial impact on the survival of HIV patients, and suggest that early ART initiation and risk reduction strategies, such as smoking cessation, may further reduce the remaining gap in survival relative to HIV-uninfected individuals,” said Marcus and colleagues.
This study is significant because it directly compared the life expectancies and measures of health of people living with HIV and HIV-negative people with equal access to health care (i.e., who were all receiving care from Kaiser Permanente in California). The researchers were able to compare similar people based on demographic information (gender, race and ethnicity) and measures of health like hepatitis infection history, CD4 count and use of drugs, alcohol and tobacco.
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The researchers reviewed the medical charts of 24,768 people living with HIV and 257,600 HIV-negative people in the Kaiser Permanente system. The researchers included over 1.6 million person-years of follow-up in their analyses.
Even though big gains in life expectancy were seen for people living with HIV, the researchers found that people living with HIV had lower life expectancies than HIV-negative people. Not having a history of hepatitis B or C, drug or alcohol abuse, smoking, and having a high CD4 count when starting ART decreased—but did not eliminate—the gap.
Here are the life expectancies at age 20 at the two different time points for people living with HIV and HIV-negative people. (Add 20 to each number to figure out the TOTAL life expectancy age.) Note the big increase over time for HIV-positive people:
In the table below are the life expectancies for people living with HIV by various demographic factors. Of note is the continuing disparity between white and Hispanic people living with HIV (who have higher life expectancies) and Black people living with HIV (who have lower life expectancies). Additionally, people with a history of using injection drugs who are living with HIV continue to have a lower life expectancy compared to men who have sex with men who are living with HIV and heterosexual people living with HIV.
|Life expectancies at age 20 of people living with HIV who are:||1996/1997||2011|
|Men who have sex with men||40.1||51.1|
|Have used injection drugs||35.9||46.0|
The researchers also looked at, in more recent years, the life expectancies for people based on a series of risk factors. Here are the life expectancies at age 20 for people living with HIV with these characteristics, plus the difference compared to the group of HIV-negative people.
|Average life expectancy at age 20 (based on 2008-2011 data)||Difference compared to HIV-negative people|
|All HIV-positive people||49.3||13.1 years lower|
|Started ART with CD4 counts greater than or equal to 500||54.5||7.9 years lower|
|No history of hep C or B||55.1||7.2 years lower|
|No drug or alcohol abuse (as classified by the ICD-9)||55.7||6.6 years lower|
|No history of smoking||56.9||5.4 years lower|
As you can see, life expectancy for people living with HIV increases when they start ART with a higher CD4 count, don’t have a history of hepatitis B or C infection, do not meet diagnostic criteria for alcohol abuse, and don’t have a history of smoking. All of these factors increase life expectancy, and lower—but do not eliminate—the gap relative to HIV-negative people.
“This continued disparity in life expectancy for HIV-infected individuals is consistent with several previous studies that compared HIV patients with the general population,” the authors note. “While HIV-infected individuals have a higher prevalence than HIV-infected individuals of lifestyle risk factors, such as smoking and substance use, most studies of life expectancy among HIV patients have compared with the general population, with limited ability to stratify with these individual-level factors. As lifespan lengthens and AIDS-related deaths decline among HIV patients, the impact on survival of smoking and other risk factors is likely to increase.”
Also important to note, the authors conclude, is that their study was conducted among people in the Kaiser Permanente health care system—so people without health insurance or otherwise outside the health care system are likely to have lower estimates of life expectancy.
Marcus, J. L. and others. Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. JAIDS. September, 2016.
Want to read more about health and wellness for people living with HIV? Check out HIV doctor, Joanna Eveland, MD, and her articles about HIV stigma, hepatitis C and HIV coinfection, making changes to drug and alcohol use, the importance of starting, and continuing ART early on, and things people living with HIV should know about what, and how to eat and their diet.