February 14, 2012
"Effective antiretroviral therapy has contributed greatly toward survival for people with HIV, yet many remain undiagnosed until very late. Our aims were to estimate the life expectancy of an HIV-infected MSM [man who has sex with men] living in a developed country with extensive access to ART and health care, and to assess the effect of late diagnosis on life expectancy," the researchers wrote.
A stochastic computer simulation model of HIV infection and ART's effect was used to estimate life expectancy and determine the distribution of potential lifetime outcomes of a 30-year-old MSM who becomes HIV-positive in 2010. The effect of altering the diagnosis rate was investigated.
Projected median age at death (life expectancy) was 75.0 years, assuming a high rate of HIV diagnosis (median CD4 cell count at diagnosis, 432 cells/µl); this implies an average of 7.0 years of life lost due to HIV. Cumulative risks of death by five and 10 years after infection were 2.3 percent and 5.2 percent, respectively. "The 95 percent uncertainty bound for life expectancy was (68.0, 77.3) years. When a low diagnosis rate was assumed (diagnosis only when symptomatic, median CD4 cell count 140 cells/µl), life expectancy was 71.5 years, implying an average 10.5 years of life lost due to HIV," according to the results.
"If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals. The greatest risk of excess mortality is due to delays in HIV diagnosis," concluded the researchers.
01.28.2012; Vol. 26; No. 3: P. 335-343; Fumiyo Nakagawa and others
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