Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV
Trickey et al. estimated the life expectancy of people with HIV (PWH) who received suppressive antiretroviral therapy (ART) after 2015, when treatment guidelines started to recommend ART for all PWH irrespective of CD4 cell count. The study used data from the Antiretroviral Therapy Cohort Collaboration (ART-CC) and the UK Collaborative HIV Cohort Study (UK CHIC).
Cohort participants on ART between 1996 and 2019 who survived for at least 1 year after ART start were considered. Information about mortality was gathered through vital statistics agencies, hospitals, physician reports and clinical follow-up of patients. The authors applied Poisson regression models to estimate mortality rate ratios, and to evaluate the impact of age, CD4 cell count, other demographics, HIV and non-HIV related covariates on mortality. Based on the models, life expectancy from age 40 was calculated.
The study included 206’891 PWH, and 5’780 deaths occurred during 619’356 person-years of follow-up. Mortality rates were lower in women compared to men (adjusted mortality rate ratio 0.85, 95% CI 0.80 – 0.91), and in individuals who started ART after 2015 compared with individuals who started before 2000 (0.58, 95% CI 0.52 – 0.66). Individuals who acquired HIV through injecting drug use (mortality rate ratio 3.93, 95% CI 3.65-4.24) and individuals with HIV/HCV coinfection (1.97, 95% CI 1.76-2.20) had the highest risk of dying during follow-up. At the age of 40 years, women who started ART after 2015 had a standardized estimated 39.0 years (95% CI 38.5-39.5) of life left. The estimated life years left for men at the same age was 37.0 years (95% CI 36.5-37.6). Compared to the general population, life expectancy in PWH was 3.8 years (women) and 1.5 years (men) shorter.
In summary, the study highlights the advances in HIV care within the last decade, which translates into a life expectancy of PWH in North America and Europe that is only a few years lower than that of people without HIV. Although these findings are reassuring for many individuals, they also reveal disparities. Further efforts are needed to reduce the mortality of key populations such as intravenous drug users or individuals with HIV/HCV coinfection, who still remain at increased risk of death.