How Long a Life Now?

posted: 26/11/2009

Thanks to the success of HIV treatment, many people with HIV are now living into older age. But how long will HIV+ people live? What can people with HIV reasonably expect?

No-one can predict accurately how long anyone will live, with or without HIV. All we can do is look for people similar to us and use their life spans as a guide.
 

Health harms

HIV is not the only thing that affects how long people live. There are a huge number of things that make a difference, from the genes we inherit from our parents, to our lifestyles – our drinking, eating, exercise habits, our weight, work, where we live, our general health - as well as things outside our control, like our class background and pollution.

Still improving

We know that life expectancy with HIV is still rising. Treatments are improving and there are good new drug prospects in the pipeline. Clinics will become better at managing HIV for older people, with more experience. Whatever life expectancy is now with HIV, we can expect it to continue to stretch nearer towards the length of life for people without HIV.

Making life sense

The information in recent studies seems confusing, but here we try to make better sense of it. We are doing this for two reasons

• people with HIV have a right to know, and
• HIV prevention messages based on a shorter life may discourage risk-taking by some people who are undiagnosed / HIV negative.

 

Large studies for the answers

Large studies comparing thousands of people with HIV with the rest of the population can tell us part of the answer to the 'how long will people with HIV live?' question.

 

 

Into 60s and beyond

One recent large international study found evidence that people taking HIV treatment can now expect to live into their 60s and beyond. The study showed someone starting successful HIV treatment aged 20 would be expected to live to be 63, and that someone starting treatments aged 35 could live to the age of 67.

It also showed the dramatic and continued decline in the risk of early death amongst people with HIV since effective HIV treatment began.

Starting treatment on time makes the difference

Importantly the researchers found that starting treatment with a CD4 cell count above 200 cells/mm3 means a person aged 20 could expect to live to be 70, and that a 35 year-old could survive into their 72nd year. Current treatment guidelines are to start treatment significantly earlier than CD4 200, and start instead at CD4 350.

• Age 20, start treatment at CD4 350  > can expect to reach age 70
• Age 20, start treatment at CD4 200  > can expect to reach age 63
• Age 35, start treatment at CD4 350  > can expect to reach age 72
• Age 35, start treatment at CD4 200  > can expect to reach age 67

10 years less, but earlier treatment adds years

Even in their most optimistic estimates, in this study the life-expectancy of HIV-positive people is about ten years less than for people who are HIV-negative. People who inject drug users and those who start HIV treatment later than recommended have shorter lives than other people with HIV – 20 years shorter for injecting drug users.
 

These results are from the Antiretroviral Cohort Collaboration - 14 large HIV cohort studies in Canada, Europe and the USA, of over 43,000 patients.
 

Late diagnosis and late starting of treatment cuts years from lives. 35 year-olds, starting treatment when the CD4 cell count is below 100 cells/mm3 can expect to reach 62, 67 if they start treatment at CD4 of 200, and by starting when CD4 is 350 (as now recommended) adds 10 years of life - to reach 72 years.

Source for the above 

 

 

Over 60s: old age, not HIV, causes deaths
A more recent study looked at people over 60 who live with HIV.

This French study found that over a four-year period, one in seven of the group died – but not a single death was due to an AIDS-defining illness – people died of ordinary diseases of old age.

The COREVIH Cohort is small, and started in 2004 with 149 patients drawn from six HIV clinics in the Paris area. Their average age at the start was 65. About 1 in 10 were in their 80s, the oldest being 86.

The average time since HIV diagnosis was 8.5 years, but this ranged from two months to 19 years.

Source for the above

 

 

Not dying soon after infection

A third study looked at deaths within five years of starting treatments. This large European study found no evidence that people died more than normal in the first five years of infection.

The European CASCADE 23 cohort collaboration, compared rates of death amongst HIV-positive people to death rates in the matching general population. It looked at 16,534 HIV-positive people infected with HIV between 1980 and 2006.

Most were infected with HIV via sex with another man (57%), 24% were heterosexual transmissions and 18% through injecting drug use.

They found that early deaths rates have been falling, and are continuing to fall, as treatments have improved. There is now almost no difference in death rates, at least within the first 5 years of infection.

But after the first five years early deaths are still a small risk. About 5 extra deaths in the first ten years of HIV infection can be expected among every 100 people. Extra deaths are more likely if people inject drugs – in the first ten years of infection more than 6 extra deaths can be expected.

Source for the above

 

 

USA: 21 years less - compare with 10 years less in European study
A recent USA study estimates people with HIV will die 21 years earlier than someone without HIV. This is very different to the best estimate from the study that included Europeans that we started this article with - which suggested 10 years less life with HIV.

Over 22,000 newly diagnosed people, from 25 of the 50 USA States (but not the major HIV states of New York and California) were included in the study.

They worked out how many years of life are lost, compared with someone of the same age, sex and ethnicity in the general population.

On average, life expectancy after diagnosis increased from 10.5 years in 1996 to 22.5 years in 2005.

HIV-positive women, had a longer life expectancy than men (23.6 years for women in 2005, compared to 21.8 years for men).
 

Among men, white men had the greatest improvement in life expectancy. USA black men diagnosed in 2005 could expect to live five years less than white men.

HIV+ white men’s life expectancy in 2005 = 25.5 years after infection (up from 10.3 years in 1996).
HIV+ black men’s life expectancy in 2005 = 19.9 years after infection (was 9.5 years in 1996).
USA gay men do best - life-expectancy for gay and bisexual men was for 28.3 years after infection in 2005. 
 

Injecting drug users have the shortest life expectancy (15.2 years for men, and 15.9 years for women in 2005).
 

Black women in USA in the early 2000s had a 20.6 year life expectancy after infection, and white women could expect 22.6 years.

The headline from this is that HIV appears to cut a USA person with HIV’s life by 21 years. This is very different to the best estimate from the study including Europeans we started this article with - which offers 10 years less life with HIV.

21 years is not as bad as it looks at first. Perhaps a significant part of the 21 less years is due to lifestyle differences between the people in the two studies, not HIV.

People who get HIV in the USA are far more likely to have a history of drink and drug use, have hepatitis C, and significant socio-economic problems, than the general population.

And many people with HIV in the USA don’t get all the HIV healthcare and treatment they need – there is no free NHS.

This means in the UK people with HIV on average would not lose so many years life as in the USA.
 

In this USA study, men could expect to die an average of 19.1 years before similar HIV-negative men, but this varies with your age. A man diagnosed aged 20 would die 25 years early, a 40-year old 18 years early, and a 60-year old 10 years early.

HIV-positive women lived an average 22.7 years less than women in the general population, but again this varies with your age. A woman diagnosed aged 20 would die 31 years early, a 40-year old 21 years early, and a 60-year old 11 years early.

Source for the above

 

What's this all mean?

We began by saying life-span prediction is not exact. We have a choice of two large studies looking at the years HIV cuts from life.

The first study suggests a loss of 10 years life is the best we can expect at present, but the last study, from USA, suggests you might lose 21 years of life. 

The two studies in the middle looked at slightly different things - would HIV kill you within the first few years after infection (answer: very unlikely) and the second looked at the causes of deaths in over 60s with HIV (answer: caused by old age, not HIV).

We think the truth, for most people diagnosed in the UK, is near to a loss of 10 years life. But this loss will shrink even more, with better treatments and better care for older people with HIV.

Treat early for a longer, better life with HIV

The biggest lesson is that once you have HIV, starting treatment as early as is recommended (at a CD4 count of 350) and taking HIV treatments properly will make the biggest difference to life length.

After HIV treatment, make your lifestyle healthier to reduce the risks of age-related ill-health damage (from smoking, drinking, drugs, lack of exercise, inadequate diet etc).

image credit - Caution Life Ahead 

image credit - 10 years ArtsMark

image credit -  Lifespan

 

Further information - prognosis factsheet from aidsmap

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