Life expectancy for a person living with HIV who is on antiretroviral therapy increased by about 10 years between 1996 to 2013, according to a new study analyzing data from Europe and North America.
The study, which was published in the Lancet HIV, looked at data from over 88,000 individuals who started HIV treatment with three or more drugs between 1996 and 2010, and who were followed for at least three years.
Overall, the researchers found that life expectancy in 20-year-old individuals starting HIV treatment in 1996 versus 2010 has increased by about nine years for women and about 10 years for men, and nearly matches the general population average of 78 years.
Within the history of HIV treatment, 1996 was important because it marked the beginning of the combination antiretroviral therapy era, after studies presented at the International AIDS Conference supported the use of triple-drug regimens.
Since then, medications have continued to improve, with regimens getting better at suppressing HIV, being less toxic and less prone to drug resistance, as well as offering reduced pill burden (taking fewer pills each day) and fewer side effects.
"Our research illustrates a success story of how improved HIV treatments coupled with screening, prevention and treatment of health problems associated with HIV infection can extend the life span of people diagnosed with HIV. However, further efforts are needed if life expectancy is to match that of the general population," said lead author Adam Trickey, Ph.D., according to the study press release.
The researchers analyzed how many people died during the first three years of antiretroviral therapy, causes of death, viral loads and CD4 counts, and whether HIV transmission occurred because of injection drug use. Based on their analysis, the researchers found that fewer people who started treatment between 2008 and 2010 died within three years, compared to individuals who started treatment between 1996 and 2007.
The number of AIDS-related deaths also decreased between 1996 and 2010. The median CD4 count after one year of treatment also increased from 370 in 1996-99 to 430 in 2008-2010. The percentage of individuals with viral loads below 500 also increased from 71% in 1996-99 to 93% in 2008-2010.
Life Expectancy Estimates
Life expectancy estimates for a 20-year-old European starting treatment in 2008-10, based on the death rates during the first three years of treatment, were 67.6 years for men and 67.9 years for women. This was still much lower than current estimates for the French general population, which are 79 years for men and 85 years for women.
In North America, based on the death rates during the first three years of treatment, life expectancy estimates for a 20-year-old starting treatment in 2008-10 were 65.9 years in men and 63.2 years in women. This is also much lower than the current estimates for the U.S. general population, which are 78 years for men and 82 years for women.
However, when basing the life expectancy estimates on death rates during the second and third years of treatment (excluding first-year deaths), the average life expectancy jumped about 10 years higher. Therefore, the researchers estimated that for a 20-year-old patient starting treatment in 2008-10, who had a CD4 count over 350 after one year of treatment, the expected age of death would be 78 years, nearly matching the general population.
Who's Left Behind?
Despite the good news, some communities are left behind from these improved life expectancy outcomes. "[I]ndividuals who are not white, have a history of injection drug use, or began [antiretroviral therapy] with low CD4 cell counts have no reduction in mortality or improvements in life expectancy," writes Ingrid T. Katz, M.D., and Brendan Maughan-Brown, Ph.D., in a comment in The Lancet HIV.
"The concern is greatest in the world's most vulnerable populations, which include people who inject drugs in Europe and North America, and individuals living in resource-constrained settings globally, where access to early [antiretroviral] initiation has been limited," Katz and Maughan-Brown add.
Life Expectancy Still Trending Up
While some groups and areas still need attention, the life expectancy estimates for those on treatment continue to rise. Last month, a study in HIV Medicine also found that life expectancy is on the rise for people with HIV on treatment, though it was lower for low-to-middle-income countries, and the overall estimates did not match the general population as closely as this latest study.
Last year, the Swiss HIV Cohort Study also found that life expectancy had increased between 1996 and 2013, from about 41 years to about 75 years.
The development of combination antiretroviral therapy certainly played a key role in increasing life expectancy, but just having treatment is not enough.
"Since modern treatment is highly effective with low toxicity, deaths in people living with HIV are unlikely to be reduced by further development of drugs. Now we need to focus on the issues surrounding drug adherence, late diagnosis of HIV, and diagnosis and treatment of co-occurring conditions. In drug users we must promote therapy and improve access to therapy to treat addictions as well as increasing access to hepatitis C treatment for people with both infections," Trickey concluded.