Growing Life Expectancy
posted: 15/12/2010
Life expectancy with HIV continues to improve. People diagnosed during 2006-08 in the UK who then keep a CD4 count of over 200, now have a life expectancy with HIV the same as the general population. This was the good news from research presented at the 10th Congress on Drug Therapy in HIV Infection in Glasgow this month.
Ending late diagnosis would add 10 years
The bad news was that late diagnosis of HIV is still a serious problem in the UK. If everyone with HIV were diagnosed before their CD4 count fell below 200, this would raise life expectancy with HIV in the UK by an astonishing ten years.
Average life 13 years less – because so many people are diagnosed late
HIV still cuts 13 years off the average person’s life expectancy, the conference heard, although ten of those lost years are due to people coming for testing late, with CD4 counts already under 200.
Men’s average life expectancy loss is twice women’s
Men’s average loss of life expectancy due to HIV is twice that of women. Men tend to neglect their health more than women and are not routinely screened for HIV, whereas sexually active heterosexual women are routinely tested in pregnancy. Late diagnosis is more common among men affecting men's average life expectancy.
A great many deaths due to HIV in the UK are simply because people tested late. The death rate in the first year after being diagnosed with a CD4 count already under 200 is 5 times higher. But people who keep a CD4 count over 200 are living longer. People diagnosed in the last 10 years lost 6.5 years on average compared with the general population, and this is still improving. In the last two years the lifespan for people with HIV who keep a CD4 count over 200 has become near-normal, presenter Margaret May said.
UK study shows rising life expectancy
The Glasgow conference was hearing results from the UK CHIC cohort study which uses data from 30 different HIV clinics in the UK.
They looked back at nearly 18,000 patients who started HIV treatment between 1996 and 2008. They left out the people most likely to have the highest and lowest life expectancies, the people who started HIV treatment when their CD4 count was above 350, and injecting drug users.
Three-quarters of the group were male, 58% gay men, and 60% white. The median age for starting treatment was 37 and the average CD4 count for starting treatment was 166.
Seven per cent,1248 people, died and they worked out the death rates for each of four three-year periods (1996-99, 2000-02, 2003-05 and 2006-08).
These were used to work out an artificial standardised mortality - life expectancy at age 20: the remaining years of life that a person could expect at their 20th birthday, regardless of their age when diagnosed with HIV.
Rising life expectancy
During the earliest period (1996-99 when effective HIV treatment started improving life expectancy) life expectancy was 30 years; in other words, a person diagnosed with HIV between 1996-1999 could expect, if they were 20, to live until they were 50. (Please do not panic if you were diagnosed during these years and are now in your late 40s. You should have more than a few years left: life expectancy rises as we age, because people who survive are more likely to continue to live.)
People diagnosed between 2006-08 on average have seen a one-third improvement to 46 years; in other words, they could expect to live until 66.
Fewer years than the general population
However, this is still 13 years less than the average life expectancy at age 20 in the general UK population. In the general population the life expectancy difference between men and women has narrowed, with improvements in early death due to heart disease in men, to only two years; a 20 year old man can now expect to live till 80 and a woman till 82.
But in the population of HIV-positive people as a whole, men have a life expectancy at age 20 of 40 years (implying that a man diagnosed with HIV can expect to live until the age of 60) and women of 50 years: exactly why this is the case will take more research.
Life expectancies are continuing to rise, however. For people diagnosed with HIV during 2006-08 who keep a CD4 count of over 200, life expectancy at age 20 is now equal to that in the general population.
Margaret May said that if everyone got diagnosed with a CD4 count of over 200, this would improve life expectancies by ten years.
“In conclusion,” she said, “we join the advocacy for improved diagnosis and timely treatment, which could improve the life expectancy of people with HIV in the UK.”
Conference website
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