The overall life expectancy of HIV-positive women in this study was less than that of MSM and HIV-negative women. The researchers suggested several possibilities for their findings. It is possible that "women may be accessing HIV-related care at later stages of HIV disease than [some] men." The study enrolled large numbers of women who had a history of injecting street drugs (IDUs). In general, people who inject street drugs have worse survival, regardless of HIV status, than non-IDUs. Women in this study may have had less education, lower incomes and more difficulty interacting with the health care system and may have experienced more social stigma and isolation than HIV-positive MSM in the study.
Unmentioned by the researchers are the many roles that women have thrust upon them, including caring for children and other family members, running a household and working outside the home. Due to these multiple roles, women sometimes are forced to prioritize the care of others and have insufficient time to care for themselves. All of these factors could have impacted the overall health and survival of women in this study.
The research team suggested that the following factors likely played a role in the poorer life expectancy of people who inject street drugs in this study:
The study team stated that the differences in life expectancy between people of colour and white people may reflect the impact of a number of factors, such as "underlying socioeconomic conditions, access to care and health insurance coverage. ..." The researchers found that at the beginning of the study the gap in life expectancy between the two racial groups was huge -- 23 years. However, toward the end of the study period, it had fallen to nine years.
The findings from the present study support recommendations by leading treatment guidelines in Canada and the U.S. that HIV-positive people should initiate ART as early as possible regardless of their CD4+ count.
It is possible that researchers may have underestimated recent or future developments in technology, care and medicine that could extend the life expectancy of HIV-positive people.
It is also possible that in the future HIV-positive people may develop age-related problems faster than HIV-negative people that cause their life expectancy to stagnate or even decrease.
Researchers were unable to follow each participant from the age of 20 until they reached their 70s. This is a reasonable limitation, as ART only became available in 1996 in most high-income countries. However, there are other databases that have monitored the health of HIV-positive people who began taking ART in 1996 (note that this is merely four years earlier than the start of the present study). These other studies have found broadly similar trends as the present NA-ACCORD analysis. The researchers in the present study used similar methodology as is routinely used to estimate the average life expectancy in HIV-negative people and so the findings from the present study are reasonable and are based on ongoing trends.
Bear in mind that compared to HIV-negative people, many HIV-positive people in Canada and similar countries are under a relatively high degree of medical scrutiny -- they undergo visits to the clinic for interviews and laboratory tests several times each year. This degree of heightened medical surveillance is likely to detect any complications early on, before they can become serious. This is yet another factor that may help extend the lifespan of HIV-positive people.
In the next article, we explore trends in survival among HIV-positive people in countries with health care systems similar to Canada and issues that can be addressed to help prolong survival.
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.
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