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Life expectancy of patients starting HIV therapy differs sharply between high and middle/low income countries
Michael Carter, 2016-09-08 07:40:00
significant disparities in the life expectancy of HIV-positive patients
starting combination antiretroviral therapy (cART) between world regions,
according to the results of a meta-analysis published in HIV Medicine. In high-income countries, a 20 year old starting treatment was
calculated to have a total life expectancy of 63 years, but in low/middle-income countries
men starting treatment at that age had a total life expectancy of 43 years and
women a life expectancy of 53 years. Life expectancy improved over time,
reflecting improvements in HIV treatment and care.
“This is the first
meta-analysis study to estimate the life expectancy of people living with HIV
after starting cART by income region,” write the authors. “We found that life
expectancy after starting cART differed markedly between income regions. There
were no gender differences in life expectancy in high-income countries, but
life expectancy was consistency higher in women than men in low/middle income
of cART in 1996 was immediately accompanied by a reduction in HIV-related
mortality. Individual studies have reported improvements in the prognosis of
cART-treated patients, with the results of some suggesting that the life
expectancy of individuals doing well on antiretrovirals is now normal.
wished to establish a better understanding of the life expectancy of
HIV-positive patients starting cART and to determine the extent to which
prognosis differed between high and middle/low income countries.
performed a meta-analysis of studies reporting on life expectancy of
The inclusion criteria were strict. Studies
were required to be cohort studies of adult HIV-positive patients who were
taking a combination of three antiretrovirals. The studies were required to
systematically report on life expectancy at age of starting cART. Mortality
data had to be gathered through active patient follow-up.
A total of eight
studies met their inclusion criteria. The articles reported on patient cohorts
in Europe, Canada, the UK, USA, Rwanda, Uganda and South Africa. The studies in
high income countries were conducted between 1996 and 2011 and the papers on
middle/low income countries reported on research conducted between 2001 and
reported on life expectancy after cART initiation at the ages of 20 and 35
included a total of 154,670 individuals, 58% of whom were men. The cohorts in
high-income countries were largely composed of men who have sex with men.
The median age at
cART initiation was 37 years and the median CD4 count at the time treatment was
started was between 100-300 cells/mm3.
The pooled life
expectancy from all the studies was 37 years and 29 years from starting cART at
the ages of 20 and 35 years, respectively. On average, a 20 year-old starting
cART would be expected to live until 57, whereas a 35-year-old would live until
64. There was significant heterogeneity in both estimates.
was then stratified according to world region and income level.
expectancy in high income countries was estimated to be 43 years if starting
cART at the age of 20 (i.e. total life expectancy of 63 years) and 32 years
when cART was started at the age of 35 (i.e. total life expectancy of 67
income countries life expectancy differed by gender.
of life when starting cART at the age of 20 years was 23 years for men and 33
years for women (men total life expectancy of 43 years; women total life
expectancy of 53 years). At the age of 35 years, life expectancy was 22 years
for men (total life expectancy of 57 years) and 30 years for women (total life
expectancy of 65 years).
believe the disparities in life expectancy by gender in middle/low income
countries reflect differences in access to HIV testing, diagnosis and retention
There was a
consistent trend for life expectancy to increase with more recent calendar year
of cART initiation. For example, a 20-year-old initiating cART in a high income
country in 2006-07 had a total life expectancy of 71 years. “We believe that
this is probably attributable to improvements in drug treatment, changing
guidelines that advocate starting cART with higher CD4 counts in all settings,
better adherence and support programmes, increased CD4 and viral load
monitoring, and cART scale-up with increased access to care in
low/middle-income countries over time,” comment the investigators.
They conclude it
is important for all countries to continue to monitor the life expectancy of
patients starting cART in order to assess the effect of changes in treatment
guidelines, care coverage and care cascades.