Treatment timing tied to longer life expectancy in HIV patients
Adult patients with HIV who started antiretroviral therapy before their CD4 counts dropped below 200 cells/mcL had life expectancies approximately 80% of that in uninfected adults, according to new data published in PLoS Medicine.
Although the findings are encouraging, especially for patients in middle- and low-income countries, greater survival may affect health care costs. The findings suggest that the pricing models life insurance companies use, as well as epidemiological estimates, may need to be revised. The current models typically assume that life expectancy after ART initiation is approximately 10 years.
Leigh F. Johnson, PhD, of the University of Cape Town in South Africa, and colleagues examined data on 37,740 HIV-positive, treatment-naive adults in six HIV treatment programs throughout South Africa between 2001 and 2010. The data were used in a relative survival model, which was developed to estimate mortality attributable to HIV by age, baseline CD4 counts and the number of years since ART initiation.
Leigh F. Johnson
Results indicated that the age of the patient was the most significant factor in determining life expectancy. For example, the average life expectancy of men starting ART ranged from 27.6 years (95% CI, 25.2-30.2) at 20 years of age to 10.1 years (95% CI, 9.3-10.8) at 60 years of age. Life expectancy was much higher for women starting ART, ranging from 36.8 years (95% CI, 34-39.7) at 20 years of age to 14.4 years (95% CI, 13.3-15.3) at 60 years of age.
Johnson and colleagues also found that life expectancies in HIV patients with baseline CD4 counts ≥200 cells/mcL were between 70% (95% CI, 62-77) and 86% (95% CI, 81-90) of those in uninfected adults of the same age and sex. Life expectancies in HIV patients who started ART with baseline CD4 counts <50 cells/mcL were between 48% (95% CI, 43-55) and 61% (95% CI, 54-67). The researchers said it was therefore critical that HIV patients start ART before their CD4 count drops below the 200 cells/mcL level.
Life expectancy increased by 15% to 20% in HIV patients who had survived 2 years after initiating ART.
The researchers said their analysis was limited by a lack mortality data at longer treatment durations. The average duration of follow-up in the study was 1.84 years.
As the number of patients initiating ART at higher CD4 counts increases, long-term survival is expected to increase as well, according to the researchers.
“It is therefore critical that appropriate funding systems and innovative ways to reduce costs are put in place, to ensure the long-term sustainability of ART delivery in low- and middle-income countries,” they wrote.
Leigh F. Johnson, PhD, can be reached at Leigh.Johnson@uct.ac.za.
Disclosure: Johnson reports no relevant financial disclosures.