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Survival After Age 50 With HIV Doubles in Nationwide Denmark Study

September 2016

Among HIV-positive people in Denmark, estimated survival from age 50 almost doubled from 11.8 years in 1996-1999 to 22.8 years in 2006-2014.1 But HIV-positive people still had shorter estimated survival than people the same age and gender in the general population of Denmark.

Survival with HIV has increased dramatically in recent years, as people take stronger, safer, and more convenient antiretroviral combinations. Some studies suggest that people with HIV are living almost as long as people without HIV. But analysis of projected survival is complicated, and not all studies find that people with HIV are close to surviving as long as HIV-negative groups. For example, a California study found that the gap in life expectancy between 24,768 people with HIV and 257,600 without HIV dropped from 44 years in 1996-1997 to only 12 years in 2011.2 But the gap persisted even in relatively healthy HIV-positive people who started antiretroviral therapy with a CD4 count above 500.

Because of increased survival with HIV, people 50 years old and older make up a growing proportion of HIV groups everywhere. Even less is known about survival with HIV in people 50 or older. To address that question, researchers in Denmark conducted a nationwide study of HIV-positive people matched by age and gender to people without HIV.


How the Study Worked

Everyone in care for HIV infection in Denmark goes to one of eight HIV centers, where care including antiretroviral therapy is free. Since January 1995, Denmark has kept electronic medical records of all these people, including data on antiretroviral treatment, CD4 count, and viral load. Other nationwide registries include regularly updated data on all Danish residents who have been admitted to a hospital in Denmark, plus data on deaths, emigration, and immigration.

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This study focused on HIV-infected people who reached the age of 50 between January 1996 and May 2014 and lived for at least 1 year after testing positive for HIV. The researchers matched every HIV-positive person to 6 people the same age and gender in the general population. The research team also identified a group of "well-treated" HIV-positive people in care between 2006 and 2014 who (1) had taken antiretroviral therapy for at least 1 year, (2) had a viral load below 500 copies and a CD4 count at or above 350 after taking antiretrovirals for 1 year, and (3) had not been diagnosed with any AIDS illness or serious non-AIDS illness. The researchers matched each of these well-treated people with HIV to 6 people in the general population who did not have HIV infection or any other serious illness.

The research team used national registries to determine time from age 50 to (1) death from any cause, (2) date of leaving Denmark, (3) date of last recorded medical visit for HIV-positive people, or (4) May 31, 2014. They used a standard statistical method to determine survival of people who entered the study group in three periods: 1996-1999, 2000-2005, and 2006-2014. This analysis gave researchers an all-cause mortality rate. The researchers also calculated a mortality rate ratio comparing mortality in the HIV group and the general-population group.


What the Study Found

The study identified 2440 HIV-positive people 50 or older and 14,588 people in the general population matched to the HIV group by age and gender. In the overall HIV group, 530 people (21.7%) died during the study period, compared with 1388 people (9.5%) in the general population.

Among people with HIV, estimated median (midpoint) survival from age 50 rose from 11.8 years in 1996-1999 to 17.8 years in 2000-2005 and to 22.5 years in 2006-2014 (Figure 1). For the general-population comparison group, median survival from age 50 was 30.2 years over the whole study period. To state those findings another way, an HIV-positive person 50 years old in 1996-1999 could expect to live to age 67.8, while an HIV-positive person 50 years old in 2006-2014 could expect to live to age 72.5. But by 2006-2014 the HIV group had not caught up to 50-year-olds in the general population, who could expect to live to age 80.2.


Expected Survival at Age 50 With or Without HIV

Expected Survival at Age 50 With or Without HIV

Figure 1. HIV-positive people who turned 50 in 2006-2014 can expect to live longer than HIV-positive people who turned 50 in 2000-2005 or 1996-1999, according to results of a nationwide study in Denmark. But expected survival of people with HIV still falls short of survival in the general population. (Credit: Teresa B. Southwell)


For the entire 1996-2014 study period, the researchers compared the chance of death from any cause with HIV versus without HIV in 5-year age groups, expressed as mortality rate ratio (Figure 2). Compared with matched people in the general population, 50-to-55-year-olds with HIV had a 3.8 times higher chance of death during the whole study period. That higher chance of death with HIV grew smaller in each older 5-year age group. But 75-to-80-year-olds with HIV still had a 1.6 times higher chance of death than matched people in the general population (Figure 2). Mortality rate ratio comparing death rates in people with versus without HIV were highest in 1996-1999 and fell in all 5-year age groups in 2000-2005 and 2006-2014.


Risk of Death by Age With Versus Without HIV

Risk of Death by Age With Versus Without HIV

Figure 2. Risk of death with versus without HIV fell in older age groups. But even at the oldest age studied, 75 to 80, people with HIV had a 1.6 times higher risk of death. (Credit: Teresa B. Southwell)


Next the researchers focused on 517 "well-treated" people with HIV who had not been diagnosed with an AIDS illness and had no serious non-AIDS illness 1 year after stating antiretroviral therapy. The investigators matched them by age and gender to 3192 people in the general population who did not have a serious illness.

Estimated median survival from age 50 in the HIV group was 25.6, compared with 34.2 years in the general-population comparison group. In other words, relatively healthy 50-year-olds with HIV could expect to live to age 75.6, compared with age 84.2 in the general population. Comparing death rates in HIV-positive people versus the general population, a mortality rate ratio of 1.7 meant these relatively healthy 50-year-olds with HIV had a 70% higher death rate.


What the Results Mean for You

This nationwide study in Denmark found that 50-year-olds with HIV can expect to live longer if they turned 50 in 2006-2014 than if they turned 50 in 2000-2005 -- and much longer than if they turned 50 in 1996-1999 (Figure 1). HIV-positive people 50 and older who avoided AIDS and serious non-AIDS illness because of antiretroviral therapy could expect to live even longer.

But the HIV groups never caught up to survival in people in the general population in Denmark who were the same age and gender. A recent comparison of 24,768 HIV-positive people in California and 257,600 people without HIV made similar findings.2

Large studies like these show that recent improvements in antiretroviral therapy and overall HIV care are helping people with HIV live much longer with their infection. But HIV-positive people still face more health challenges than people without HIV. These challenges include higher rates of some serious diseases like heart disease, cancer, diabetes, and liver or kidney disease. HIV-positive people should work with their healthcare providers to watch out for non-AIDS diseases that may pose a particular threat and take steps to lower chances of getting those diseases. HIV-positive people who already have one of these non-AIDS diseases can take steps to control them.

The most important thing you can do to live longer with HIV is taking all your antiretrovirals regularly, exactly as your provider instructs. If you have trouble taking your pills regularly, talk to your provider about finding ways to improve your pill taking. Sometimes it may be possible to switch to an antiretroviral combination that you find easier to take.

Taking good care of your overall health is important for everyone with HIV, but especially for people 50 and older. Whether a person has HIV or not, many serious diseases become more frequent as a person ages. This study found that people 50 and older who control their HIV infection and avoid AIDS and serious non-AIDS diseases can expect to live longer than people who acquire those diseases.


References

  1. Legarth RA, Ahlström MG, Kronborg G, et al. Long-term mortality in HIV-infected individuals 50 years or older: a nationwide, population-based cohort study. J Acquir Immune Defic Syndr. 2016;71:213-218.
  2. Marcus JL, Chao C, Leyden W, et al. Narrowing the gap in life expectancy for HIV+ compared with HIV- individuals. Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston. Abstract 54.


Related Stories

Life Expectancy Rising in HIV Group Over 50, But Still Lags General Population
Older People With HIV Face Different Long-Term Health Challenges
Earlier Start of Antiretroviral Therapy Impacts Aging With HIV (Video)



This article was provided by The Center for AIDS Information & Advocacy. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.
 

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