HIV-positive individuals who start antiretroviral treatment early are now considered to have a normal life expectancy. But once everyone living with the virus is factored in, there remains a nine-year gap in life expectancy between those with and without HIV. What’s more, HIV-positive people are expected to develop various major health problems 16 years earlier than their HIV-negative peers.
Julia Marcus, PhD, MPH, of Harvard Pilgrim Healthcare Institute, and colleagues conducted a study of people who received care and insurance coverage from Kaiser Permanente between 2000 and 2016. Every person with HIV (39,000) was matched with 10 people without the virus (nearly 390,000) based on their age, sex, race, year and medical center.
The study looked at six major health problems: chronic liver, kidney and lung disease, diabetes, cancer and cardiovascular disease.
Life expectancy was defined as the number of years an individual was expected to live past age 21. Overall life expectancy rose from 38 additional years for HIV-positive people and 60 additional years for HIV-negative people during 2000 to 2003 to an additional 56 and 65 years, respectively, during 2014 to 2016.
During 2014 to 2016, HIV-positive 21-year-olds were expected to develop major health problems after just 15 years, compared with 31 years among their HIV-negative peers—a gap that held constant during the study period.
By the end of the study period, those people with HIV who started antiretroviral treatment with a CD4 count of at least 500 had an essentially normal life expectancy. However, initiating HIV treatment relatively soon after acquiring the virus did not change the number of additional years that HIV-positive 21-year-olds could expect to live without major health problems.
“It’s fantastic to see that life expectancy is continuing to improve for people with HIV,” says Marcus. “Now we need to focus our efforts on making sure those life years are as healthy as possible.”