Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study

Abstract

Objectives To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm 3 at start of antiretroviral therapy.Design Cohort study.Setting Outpatient HIV clinics throughout the United Kingdom.Population Adult patients from the UK Collaborative HIV Cohort (UK CHIC) Study with CD4 count ≤350 cells/mm 3 at start of antiretroviral therapy in 1996-2008.Main outcome measures Life expectancy at the exact age of 20 (the average additional years that will be lived by a person after age 20), according to the cross sectional age specific mortality rates during the study period.Results 1248 of 17 661 eligible patients died during 91 203 person years' follow-up. Life expectancy (standard error) at exact age 20 increased from 30.0 (1.2) to 45.8 (1.7) years from 1996-9 to 2006-8. Life expectancy was 39.5 (0.45) for male patients and 50.2 (0.45) years for female patients compared with 57.8 and 61.6 years for men and women in the general population (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) Conclusions Life expectancy in people treated for HIV infection has increased by over 15 years during 1996-2008, but is still about 13 years less than that of the UK population. The higher life expectancy in women is magnified in those with HIV. Earlier diagnosis and subsequent timely treatment with antiretroviral therapy might increase life expectancy. IntroductionHIV infection has become a chronic disease with a good prognosis provided treatment is started sufficiently early in the course of the disease and the patient is able to maintain lifelong adherence to antiretroviral therapy. 1 2 Mortality rates have decreased such that, compared with the general population, the risk of death in successfully treated patients is similar to that of people with unhealthy lifestyles (such as heavy smoking, drinking, or obesity) or other chronic conditions such as diabetes.3 Although previous studies have compared mortality rates in patients with HIV with those in the general population [3][4][5][6] or have reported the prognosis of patients with HIV by estimating cumulative probability of death, 7 few have estimated how long those with HIV are likely to live.Estimates of life expectancy are important to individuals who want to plan their lives better, to service providers, and to policy makers. Patients might use this information to inform decisions on when they start antiretroviral therapy and treatment of comorbidities, pension provision, starting a family, or buying a house. Service providers require estimates of life expectancy to project the number of people with HIV who will need treatment and the future costs of providing antiretroviral therapy. Policy makers in the health service will be interested in addressing inequalities in life expectancy between patients with different characteristics, such as race or sex, or between those with early or delayed initia...

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