People with HIV who receive timely antiretroviral treatment before they experience serious immune deficiency may reach a lifespan comparable to that of the HIV negative general population, according to two European studies presented at CROI.
Dutch researchers reported findings from ATHENA (abstract 526), a long-term national observational study in the Netherlands. This analysis included 4,612 participants enrolled between 1998 and 2007 who had not yet started ART at 24 weeks after HIV diagnosis; about 75% had a CD4 cell count above 350 cells/mm3 at baseline, and planned to start therapy when it fell below this level.
For an asymptomatic HIV positive person at age 25, the expected median remaining duration of life was 52.7 years, versus 53.1 years for the general population, a difference of just five months; by age 55, the difference had increased to 1.3 years for men and 1.5 years for women. However, men and women who did not start ART until after they developed CDC stage B disease -- indicating symptomatic HIV disease but no AIDS-defining conditions -- lost 6.0 and 7.5 years of life, respectively, by age 55.
In the second study (abstract 527), investigators compared age- and sex-specific death rates in the general population and among 80,642 HIV positive participants in COHERE, a collaboration of 25 European observational cohorts who started combination ART for the first time after 1997; here, the median CD4 count was lower, at 225 cells/mm3.
Individuals who started ART with fewer than 200 cells/mm3 had a 13-fold higher risk of death compared with the general population, falling to a three-fold risk if starting with 200-349 cells/mm3, and about twice the risk with 350-499 cells/mm3. Men with a CD4 count of 500 cells/mm3 or higher had a risk of death statistically equivalent to that of age-matched HIV negative men after three years on ART; women, however, remained at about double the risk of HIV negative women even after five years of treatment.
Liz Highleyman (firstname.lastname@example.org) is a freelance medical writer based in San Francisco.
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