Overall, not comorbidity-free, life expectancy gap narrowed between HIV+, HIV- persons

The gap in overall life expectancy between people with HIV (PWH) and those without HIV has narrowed over time, particularly among optimally treated PWH. However, PWH still have fewer comorbidity-free years than those without HIV, according to a study presented at CROI 2020.

“Life expectancy has increased further for PWH, with no remaining gap in lifespan between PWH who initiated antiretroviral therapy (ART) at high CD4 counts and people without HIV,” said study investigator Assistant Professor Julia Marcus from Harvard Medical School, Boston, Massachusetts, US.

“[However,] PWH live substantially fewer healthy years than people without HIV, with no improvement over time or with ART initiation at high CD4 counts,” she said.

The study population comprised adult members of Kaiser Permanente in Northern or Southern California, or District of Columbia, Maryland, and Virginia, US, between 2000 and 2016. PWH (n=39,000) were matched 1:10 with uninfected individuals (n=387,767) based on age, sex, race/ethnicity, medical centre, and calendar year (mean age 41 years, 88 percent male, 45 percent Caucasian). Clinical and mortality data were obtained from health records, registries, and datasets. Remaining years of life expectancy – overall and comorbidity-free – were assessed from age 21 years. Among PWH, 18 percent had initiated ART prior to baseline, while 64 percent initiated ART during the follow-up period.

At age 21 years, overall life expectancy increased over the follow-up period among people without HIV, from an expected 60 years remaining during the years 2000–2003 to 65 years remaining in 2014–2016. [CROI 2020, abstract 151]

Overall life expectancy also increased among PWH, going from 38 years remaining in 2000–2003 to 56 years remaining in 2014–2016.

“[This means] that a person with HIV, given survival until age 21 [years], could be expected to live to age 77 [years],” said Marcus.

Among individuals without HIV, comorbidity-free life expectancy at age 21 years was 27 years in 2000–2003 and increased to 31 years remaining in 2014–2016. Among PWH, comorbidity-free life expectancy increased from 11 years remaining in 2000–2003 to 15 years in 2014–2016.

Specifically, chronic liver disease-free life expectancy among PWH vs those without HIV was 23 vs 54 years in 2000–2003, and 34 vs 58 years in 2014–2016. Chronic kidney disease-free life expectancy was 34 vs 55 years in 2000–2003 and 41 vs 58 years in 2014–2016. Chronic lung disease-free life expectancy was 18 vs 35 years in 2000–2003 and 26 vs 42 years in 2014–2016.

“There was a wide gap in comorbidity-free life expectancy for each of these comorbidities by HIV status and this gap did not narrow over time,” noted Marcus. “PWH live 16 fewer comorbidity-free years than people without HIV.”

Conversely, the gap by HIV status with regard to diabetes, cardiovascular disease (CVD), and cancer appeared to narrow over time (diabetes: 31 vs 46 years remaining in PWH vs those without HIV in 2000–2003 and 44 vs 52 years in 2014–2016; CVD: 36 vs 54 years remaining in 2000–2003 and 53 vs 61 years in 2014–2016; cancer: 34 vs 54 years remaining in 2000–2003 and 50 vs 59 years in 2014–2016).

“For these three comorbidities, we saw a narrower gap by HIV status that did improve over time,” said Marcus.

In PWH who initiated ART at a CD4 count of ≥500, there was no remaining gap in overall life expectancy compared with people without HIV (66 vs 64 years in 2011–2016). However, there remained a gap between PWH and people without HIV in terms of comorbidity-free life expectancy (13 vs 29 years). There was an improvement noted in cancer and CVD-free life expectancy, but not in diabetes, or liver, lung, or kidney disease.

“[While] ART has dramatically increased life expectancy for PWH … greater attention to comorbidity prevention is needed [in this population],” Marcus concluded.