Making the Right Comparisons
Regardless of HIV infection status, differences in survival by neighbourhood can vary by city, region or even within a country. For instance, Professor Sabin stated that overall male life expectancy at birth in the years 2007 to 2009 was about 84 years in parts of London, compared to 73 years for males who were living in parts of Glasgow. She said that this and other differences in life expectancy among HIV-negative people can be explained by "differences in the characteristics of those living in different regions, particularly socioeconomic status, lifestyle factors and dietary factors." Thus, she argues that when making comparisons between HIV-negative and HIV-positive people, it is probably useful to match each HIV-positive person to an HIV-negative person who has similar "lifestyle and behavioural characteristics ..." so that a more accurate estimation of life expectancy can be obtained.
In one study comparing HIV-positive and HIV-negative people in the U.S. several years ago, researchers found that life expectancy for the average HIV-negative person was about 76 years. When researchers recalculated the life expectancy in their study using HIV-negative people with similar behaviours and characteristics of their HIV-positive population, the average life expectancy of this group of HIV-negative people fell to 68 years. Adjusting estimations of life expectancy -- taking into account alcohol use, tobacco smoking, use of other substances, consequences of sexually transmitted infections (STIs) -- is an important point that needs to be considered. When the U.S. researchers took these factors into account and estimated the life expectancy of their HIV-positive population, they arrived at a figure of about 56 years.
Increasing Life Expectancy for HIV-Positive People
The studies that we have reported on in this issue of TreatmentUpdate suggest that there is still much work to be done raising the life expectancy of key populations who have HIV. Such work needs to be focused on care and treatment issues mainly unrelated to HIV, likely including at least the following themes:
- screening for and treatment of anxiety, depression, post-traumatic stress disorder and schizophrenia
- help with recovery from addiction and substance use
- among people with hepatitis B or C co-infections, reducing alcohol consumption is particularly important for maintaining liver health
- encouragement and support for quitting smoking
- maintaining a healthy weight
- monitoring of and assistance with taking medicines every day exactly as directed
- screening for and treatment of HCV and other co-infections
- screening for and preventing and treating cardiovascular and kidney disease as well as diabetes
- getting vaccinations against common infections
- regular cancer screening and, when necessary, treatment
- screening and treatment of STIs as well as vaccination against hepatitis A and B and human papillomavirus (HPV)
Until these and other measures become routine across North America for all groups hit hard by HIV, gaps in survival between the different groups mentioned in these and other studies will persist.
- Sabin CA. Do people with HIV infection have a normal life expectancy in the era of combination antiretroviral therapy? BMC Medicine. 2013 Nov 27;11:251.
- Tavernise S. List of smoking-related illnesses grows significantly in U.S. report. New York Times. 17 January, 2014. [Subscription may be required]
- Marin B, Thiébaut R, Bucher HC, et al. Non-AIDS-defining deaths and immunodeficiency in the era of combination antiretroviral therapy. AIDS. 2009 Aug 24;23(13):1743-53.
- Losina E, Schackman BR, Sadownik SN, et al. Racial and sex disparities in life expectancy losses among HIV-infected persons in the United States: Impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy. Clinical Infectious Diseases. 2009 Nov 15;49(10):1570-8.
- Helleberg M, Afzal S, Kronborg G, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clinical Infectious Diseases. 2013 Mar;56(5):727-34.
- Lewden C, Chene G, Morlat P, et al. HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach same mortality rates as the general population. Journal of Acquired Immune Deficiency Syndromes. 2007 Sep 1;46(1):72-7.
- Krentz HB, Kliewer G, Gill MJ. Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003. HIV Medicine. 2005 Mar;6(2):99-106.
- Druyts EF, Rachlis BS, Lima VD, et al. Mortality is influenced by locality in a major HIV/AIDS epidemic. HIV Medicine. 2009 May;10(5):274-81.
- Cohen MH, French AL, Benning L, et al. Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy. American Journal of Medicine. 2002 Aug 1;113(2):91-8.
- Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, et al. All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population: evidence from a large European observational cohort collaboration. International Journal of Epidemiology. 2012 Apr;41(2):433-45.
- Samji H, Cescon A, Hogg RS, et al. Closing the Gap: Increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013 Dec 18;8(12):e81355.