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Read Now: TheBodyPRO.com Covers AIDS 2014

Longer Life Expectancy for HIV-Positive People in North America

January 2014

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Large studies, primarily from Western Europe, the U.S. and Australia, have found that potent combination anti-HIV therapy (commonly called ART or HAART) has led to tremendous improvement in the health of HIV-positive people. In Canada and other high-income countries, AIDS-related infections are uncommon for HIV-positive people who are in care and who are taking ART. As a result, researchers increasingly expect that a young adult who is infected with HIV today and who begins ART shortly thereafter and who takes his or her medicine every day exactly as directed and who does not have untreated co-existing health issues -- such as addiction, depression, schizophrenia, co-infection with hepatitis C virus -- is likely to live for several decades.

Until recently, analyses of life expectancy for large numbers of HIV-positive people in Canada and the U.S. were not available. Now a consortium of researchers across the continent has pooled health-related data collected from HIV-positive people and analysed their life expectancy. The researchers found that overall the life expectancy for HIV-positive people has increased over the past decade and is approaching that of HIV-negative people. However, not all key groups affected by HIV are experiencing the same degree of life expectancy. In this bulletin we explain which groups are affected and offer possible reasons for the observed differences.


Study Details

Researchers across North America with the NA-ACCORD database analysed health-related information from 22,937 participants who initiated ART between January 1, 2000 and December 31, 2007.

The average profile of participants was as follows:

  • 77% were male, 23% were women

Participants were distributed across the following age ranges:

  • 20 to 34 years: 25%
  • 35 to 44 years: 42%
  • 45 to 54 years: 25%
  • 55+ years: 8%
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Route of infection

  • sharing equipment for injecting street drugs (IDUs): 20%
  • having unprotected sex with another man  (MSM): 39%
  • other, unspecified routes of infection: 41%

Race/ethnicity

  • people of colour: 62%
  • white people: 38%

CD4+ count at the time ART was initiated:

  • less than 350 cells: 72%
  • 350 or more cells: 28%


Results -- Overall

A total of 1,622 people died during the study; details about causes of death were not provided.

In general, rates of death were high among groups of people with the following features/characteristics:

  • a history of injecting street drugs
  • people of colour
  • people who started ART when their CD4+ count was 350 or less


Life Expectancy -- The Numbers

Based on its analysis, the research team predicted that the average life expectancy of a 20-year-old person in the U.S. or Canada who began ART shortly after he or she became HIV positive should be around 70. However, this is just an average figure, and some groups will have shorter or longer life expectancy. Below are the estimated life expectancies of a 20-year-old person in different groups in 2009, starting with HIV-negative people for comparison. At the end of the figures we provide possible explanations for these results:

  • HIV-negative men in Canada: 80 years
  • HIV-negative men in the U.S.: 77 years
  • HIV-negative women in Canada: 84 years
  • HIV-negative women in the U.S.: 82 years

Gender

  • HIV-positive men: 62 years
  • HIV-positive women: 64 years

Route of infection

  • IDUs: 49 years
  • MSM: 77 years
  • other risk groups: 70 years

Race/ethnicity

  • people of colour: 58 years
  • white people: 72 years

CD4+ count when ART was initiated

  • less than 350 cells: 59 years
  • 350 or more cells: 75 years

These life expectancies should be compared to the time before ART became available when, on average, HIV-positive people in high-income countries lived for between 10 and 12 years after diagnosis.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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