Life Expectancy of People Receiving Modern HIV Treatment Explored in Recent Study

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Life Expectancy of People Receiving Modern HIV Treatment Explored in Recent Study

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Life Expectancy of People Receiving Modern HIV Treatment Explored in Recent Study

According to a study published in The Lancet HIV journal, individuals infected with the human immunodeficiency virus (HIV) who undergo effective modern antiretroviral therapy (ART) and maintain a high CD4 T-cell count can expect to live as long as HIV-negative individuals.

However, those with low CD4 cell counts face a less favorable prognosis, emphasizing the importance of initiating treatment before severe immune system damage occurs.

The researchers noted, “For HIV-infected individuals receiving antiretroviral therapy and those with high CD4 cell counts, survival to 2015 or initiating antiretroviral therapy after 2015 resulted in life expectancies only a few years lower than the general population. However, for those with low CD4 cell counts at baseline, life expectancy estimates were significantly lower, highlighting the ongoing importance of early HIV diagnosis and continuous treatment.”

Since the approval of the first antiretroviral drug AZT (Retrovir) in 1987, significant progress has been made in HIV treatment. In the late 1990s, high-income countries widely adopted combination therapy, substantially increasing life expectancy. Today, treatment is convenient, well-tolerated, and effective. However, even in individuals with undetectable viral loads, ongoing immune activation and inflammation may lead to various health issues, raising concerns about potential life shortening.

Dr. Adam Trickey from the University of Bristol and an international team estimated the life expectancy of adult HIV-infected individuals in North America and Europe who received antiretroviral therapy for at least one year since 2015. The World Health Organization changed treatment guidelines in that year, recommending antiretroviral therapy for all diagnosed with HIV, irrespective of CD4 cell counts. This study focused on 206,891 individuals who began treatment between 1996 and 2019, with follow-up starting in 2015.

The analysis revealed that individuals starting treatment before 2015 were older, had a longer average treatment duration, lower CD4 cell counts, and some had used less effective and less tolerable older antiretroviral drugs. Those starting treatment after 2015 were more likely recently diagnosed, with lower CD4 cell counts and higher average viral loads.

The researchers estimated remaining life expectancy at age 40 and compared it with general population estimates, considering various variables associated with mortality.

For men, starting antiretroviral therapy before 2015 resulted in an estimated remaining life expectancy of 34.5 years at age 40 (total 74.5 years), while initiating treatment after 2015 increased it to 37.0 years (total 77.0 years). For women, the respective estimates were 35.8 years (total 75.8 years) and 39.0 years (total 79.0 years).

People with CD4 counts of 500 or higher at baseline had longer life expectancies, comparable to the lower end of the normal range for HIV-negative individuals. Men with high CD4 counts starting treatment before 2015 could expect to live 38.0 years (total 78.0 years), and if treatment started later, 39.2 years (total 79.2 years). The estimates for women with similarly high CD4 cell counts were 40.2 years (total 80.2 years) and 42.0 years (total 82.0 years). These estimates align with life expectancies for age-matched individuals in the general population (approximately 81 years for men and 86 years for women).

However, individuals with CD4 counts below 50 at baseline experienced a shortened life expectancy of around 20 years. Men with very low CD4 counts starting treatment before 2015 were estimated to live an additional 18.2 years (total 58.2 years), and if treatment started later, 23.7 years (total 63.7 years). For women, the respective estimates were 19.4 years (total 59.4 years) and 24.9 years (total 64.9 years).

Factors influencing mortality risk after adjustments included current age and the severity of immune deficiency. The risk of death for individuals with CD4 counts below 50 was five times higher than those with counts above 500, and those with counts between 100 and 199 (meeting AIDS diagnostic criteria) had a threefold higher risk than those with counts above 500. Even individuals with less severe immune suppression (CD4 counts between 200 and 350) faced a twofold higher risk of death than those with counts above 500.

Other risk factors included older age, slightly higher mortality risk in males compared to females, approximately 2.5 times higher death risk for those infected through drug injection compared to other transmission routes, and a slightly higher death risk for heterosexual transmission compared to male-male transmission.

Individuals starting treatment after 2015 had better outcomes. Compared to those starting treatment in 2015 or later, those starting treatment in 1996-1999 had a roughly 30% higher risk of death, while those starting in 2000-2014 fell in the intermediate risk range.

At baseline, individuals with viral loads over 50 had approximately 30% higher death risk than those with undetectable viral loads, and those co-infected with hepatitis C faced approximately 40% higher death risk. However, the impact of other factors, including lowest CD4 cell counts, prior monotherapy, and prior use of less tolerable early antiretroviral drugs like AZT, was relatively minor.

The study focused solely on life expectancy and not on health-related quality of life. Even HIV-positive individuals receiving effective antiretroviral therapy with currently high CD4 cell counts often experience more health issues at earlier ages than their HIV-negative counterparts. Importantly, HIV-infected individuals have additional risk factors, such as hepatitis C or smoking.

The authors emphasized that in high-income countries, most deaths among HIV-infected individuals receiving antiretroviral therapy result from non-HIV-related causes, such as cancer and cardiovascular diseases. They concluded, “Managing and preventing complications in HIV-infected individuals is crucial for ensuring quality of remaining life. Initiating antiretroviral therapy in a timely manner—meaning reducing the time of active virus replication that damages the immune system—can reduce the risk of poor health and death.”

The researchers hope their findings can be generalized to other high-income countries where HIV-positive adults receive antiretroviral therapy, but they acknowledge that relevance may be limited in low- and middle-income countries or environments where treatment access is restricted or costly.

Dr. Marina Klein, a medical doctor from the McGill University Health Centre in Montreal, commented in an accompanying editorial, “Normal life expectancy brings hope: a person can reach milestones, contribute to society, dream—in short, live. Eliminating the stigma associated with HIV requires dispelling fear of infection. Knowing that the life expectancy of people living with HIV is nearly the same as that of the general population can help alleviate this fear and encourage people to come forward for HIV testing and care, and disclose their HIV status to their partners. Simple things, such as being able to obtain life insurance and retirement plans, can help people living with HIV lead normal lives.”

Life Expectancy of People Receiving Modern HIV Treatment Explored in Recent Study

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