Conference on Retroviruses and Opportunistic Infections (CROI)

Conference on Retroviruses and Opportunistic Infections (CROI)

March 11, 2020
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Early ART narrows life expectancy gap for people with HIV to zero

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Julia L. Marcus

The gap in life expectancy between people with HIV and people without HIV has narrowed, and initiating ART early shortens it even further, giving people with HIV the same life expectancy as people without it, according to findings from CROI.

“We know that antiretroviral therapy has dramatically increased life expectancy for people with HIV,” Julia L. Marcus, PhD, MPH, infectious disease epidemiologist and assistant professor of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, told Healio.

“In a previous study, we found a 13-year gap in life expectancy between people with and without HIV in 2008-2011, with a 9-year gap for people with HIV who initiated antiretroviral therapy with high CD4 counts. We decided to do this new study to answer two key questions. First, has the life expectancy gap narrowed further? And second, how many of those life years are healthy, or lived without major chronic comorbidities?”

To answer these questions, Marcus and colleagues conducted a cohort study of adult members of Kaiser Permanente in Northern or Southern California or mid-Atlantic states from 2000 to 2016. According to the study abstract, people with HIV were matched 1:10 with uninfected adults based on age, sex, race, medical center and year. The researchers used abridged life tables to estimate the average number of total and comorbidity-free years of life remaining at age 21.

The gap in life expectancy between people with HIV and people without HIV has narrowed, and initiating ART early shortens it even further, giving people with HIV the same life expectancy as people without it.

According to Marcus, they found an overall 9-year gap in life expectancy between people with and without HIV in 2014 to 2016. Among people who initiated ART with CD4 counts above 500, there was no remaining gap in life expectancy compared with people without HIV. Data from Marcus’s presentation showed people with HIV have an overall life expectancy of 56 years at age 21, compared with 65 years for those without HIV.

However, the researchers found that people with HIV lived 16 fewer comorbidity-free years than people without HIV, and this did not improve over time. For people with HIV who initiated ART with CD4 counts above 500, the gap in healthy life years was narrower for several but not all comorbidities.

“Our results confirm the lifelong benefits of initiating antiretroviral therapy at high CD4 counts but also highlight the need for greater attention to comorbidity prevention for people with HIV,” Marcus concluded. – by Caitlyn Stulpin

Reference:

Marcus JL, et al. Abstract 151. Presented at: Conference on Retroviruses and Opportunistic Infections; March 8-11, 2020; Boston.

Disclosures: Marcus reports consulting for Kaiser Permanente Northern California on a research grant from Gilead Sciences.