The average 20-year-old who starts HIV treatment today can likely expect to live 10 years longer compared with one who began taking antiretrovirals (ARVs) in the early days of effective combination regimens. Since the advent of combination ARVs in 1996, both HIV treatment and the overall medical care of people living with the virus have improved.
Publishing their findings in The Lancet, researchers analyzed data from 18 European and North American cohort studies of people living with HIV, age 16 years and older. The participants were eligible for the studies if they had started HIV treatment with three or more ARVS between 1996 and 2010 and had the potential for at least three years of follow-up in their respective studies.
All told, the analysis looked at data on 88,504 people. A total of 2,106 of them died during their first year on ARVs, and 2,302 died during their second or third year on treatment.
Between 1996 and 1999, most individuals started a protease inhibitor–based regimen; after that time, non-nucleoside reverse transcriptase inhibitor (NNRTI)–based regimens predominated.
Compared with those who started ARVs during 2000 to 2003, those who started during 2008 to 2010 had a 29 percent lower rate of death from all causes during their first year on treatment. During their second and third years on ARVs, those who started during 2008 to 2010 had a 43 percent lower death rate than those who started during 2000 to 2003. The researchers found that this drop was not fully explained by improvements in viral load and CD4 measures, suggesting that other components of overall medical care may have played a hand.
Looking just at non-AIDS-related death rates, the researchers found that compared with those who started ARVs during 2000 to 2003, those who started during 2008 to 2010 had a 52 percent lower death rate during their first year on treatment and a 71 percent lower death rate during their second and third years on treatment.
Basing their estimates on death rates during the first three years after individuals started ARVs, the investigators found that life expectancy for 20-year-olds starting treatment between 2008 and 2010 was higher for Europeans than for U.S. residents. For Europeans, life expectancy was 67.6 years for men and 67.9 years for women, while for U.S. residents the respective figures were 65.9 years and 63.2 years. By comparison, average life expectancy in France is 79 years for men and 85 years for women; in the United States, the respective figures are 78 years and 82 years.
Between 1996 and 2010, average life expectancy for 20-year-olds starting ARVs increased by an estimated nine years for women and 10 years for men. Additionally, the average age of death for a 20-year-old starting ARVs with a CD4 count greater than 350 during 2008 to 2010 was 78 years. This latter estimate is excellent news considering the recent push to get people with HIV on treatment as soon as possible after diagnosis, preferably with a CD4 count higher than 500.
The researchers believe that the continued improvement in survival during the first three years after individuals start ARVs has likely been driven by lower toxicities in modern treatments, improved adherence to treatment regimens, efforts to prevent other health conditions among people with HIV and better management of other health conditions that do arise.
To read the study, click here.