by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
May 5, 2020
Featured Literature:
Marcus JL. INCREASED OVERALL LIFE EXPECTANCY BUT NOT COMORBIDITY-FREE YEARS FOR PEOPLE WITH HIV. CROI 2020, Boston, MA. Abstract # 151.
The life expectancy for persons with HIV (PWH) is often noted in the post-ART era to be “normal” or “similar” to those without HIV. However, this opinion is perhaps more observational than quantitatively factual. This study included a large cohort (N=39,000) of adult PWH who lived in California, Maryland, Virginia, and the District of Columbia. They were matched 1:10 for ethnicity/race, sex, calendar year, and site of medical care to uninfected adults. These patients were in care from 2000 to 2016. The authors used abridged life tables to estimate the average number of total and comorbidity-free years of life remaining, beginning at age 21 by calendar year. The co-morbidities specifically looked at included: cancer, cardiovascular disease, diabetes, liver disease, renal disease, or respiratory disease. Among the 39,000 PWH there were 2,661 deaths compared to 9,147 deaths in the control group which translated to mortality rates of 1,303 verses 390 per 100,000 person years. From 2000-2003, life expectancy at age 21 was about 58 for persons with HIV compared to 79 for those without HIV – a gap of about 20 years. Over time, life expectancy for both groups improved and in 2016 a PWH was expected to live until age 77 compared to age 86 for someone not infected – a significant gap of nine years. However, for those who initiated ART with a CD4 count > 500 cells/mm3 the study found no difference in life expectancy. In regards to comorbidities, persons with HIV were likely to have first onset of one of these conditions at age 37 compared to age 52 in persons without HIV. This number has not improved over time. For persons who initiated ART with a CD4 count > 500 cells/mm3 there was a decrease in incidence of CVD and cancer but not diabetes, kidney, liver or lung disease, renal disease.
Author’s Commentary:
This is an important study rich with data that has significant clinical implications for our patients. While it is true patients with HIV are living longer, life expectancy across the board is NOT the same as those without HIV, except for those who had a normal CD4 count at the time of diagnosis and had early initiation of ART. This supports our goals of early diagnosis and treatment known to be imperative for a variety of reasons, including preventing new infections. Conversely, HIV infections appears to still confer increase risk for co-morbid illness with a much earlier onset than in persons without HIV, resulting in “fewer healthy years.” I would encourage you to watch the FULL presentation of this study by Dr. Julia Marcus at the link below.
The author has no conflicts of interest to disclose.
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