Many HIV+ Persons Who Respond Well to Treatment Have Near-Normal Life Expectancy

The overall health of millions of persons living with HIV has improved dramatically in the two decades since effective combination antiretroviral therapy (ART) first became available in the mid-1990s. In recent years, a number of studies have also documented large increases in the life expectancy of some HIV-positive persons -- especially those who are diagnosed relatively early in the course of infection and who receive treatment promptly. Now a very large study has confirmed that people who respond well to ART during their first year on treatment achieve a near-normal life expectancy.

In the study, a multinational research group known as the Antiretroviral Therapy Cohort Collaborative analyzed data from 18 European and North American cohort studies that tracked the health of nearly 90,000 persons who started ART during different time periods, ranging from 1996 to 2010. In particular, the researchers examined death rates during the first three years after people started ART and used that information to estimate future life expectancy.

They found that, between 1996 and 2010, the average life expectancy of people receiving ART increased about ten years for both men and women. For people who started ART between 2008 and 2010 and who were still alive with a CD4 T-cell count over 350 a year after beginning treatment, their life expectancy is similar to that of the general (non-HIV-infected) population.

For example, the researchers estimate that a 20-year-old who started and responded well to ART during that period could expect to live, on average, to the age of 78. However, the study shows that, compared to the general population, people starting ART treatment still have an increased risk of death during the first year of treatment -- a period when some have low CD4 counts that place them at risk for life-threatening opportunistic illnesses.

It is also worth noting that the overall life expectancy figures are averages and do not mean that all groups benefit equally well. In particular, people who inject drugs and those who start ART with low CD4 cell counts have lower life expectancies than people who do not inject drugs and start ART with higher CD4 counts. Interestingly, the life expectancy benefits of ART were somewhat better in Europe than in North America.

The researchers also found that the direct effects of ART -- reduced viral load and higher CD4 counts -- weren't the only factors that increased the life expectancies of HIV-positive persons receiving treatment. Improved care for other health conditions, such as heart disease, diabetes, and malignancies, also had an impact.

The study indicated that, over the years, there were particularly large decreases in the death rates due to heart and liver disease, including hepatitis C (HCV). Since the study included only persons who started ART between 1996 and 2010, it does not provide any information about the additional health benefits people coinfected with HIV drug regimens that have become available during the past few years.

Eric Brus writes about HIV policy. His HIV/AIDS Disparities Report is produced by the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.