Comorbidities And Healthy Aging
Because modern-day HIV medications are highly effective and well-tolerated, interventions that improve the life expectancies of people living with HIV will need to address other health conditions that may affect people living with HIV at a disproportionate rate or more severely.
Improving the health of people growing older with HIV is a critical priority, said Harris, Rabkin and El-Sadr, in an editorial published in AIDS. Older adults living with HIV may experience more severe side effects of antiretroviral medications, higher risk of kidney disease, declines in bone mineral density, peripheral neuropathy and cardiovascular disease. An estimated 6.9 million people living with HIV will be over age 50 by the year 2020.
The greying of the epidemic raises important questions regarding understanding the effect of aging on people living with HIV, the effect of HIV infection on the aging process, and optimal approaches to HIV prevention among older adults, said Harris and colleagues.
Harris, T. G., Rabkin, M. and El-Sadrr, W. M. Achieving the fourth 90: healthy aging for people living with HIV. AIDS, 2018.
Life Expectancy Outside Of High
However, in low- and middle-income countries, the life expectancy picture isnt as clear. Whilst there have been fewer studies undertaken, theres certainly been a marked decline in deaths from HIV.
In South Africa, the country with the largest population of people living with HIV, a recent study also showed life expectancy to be near normal for those people who started treatment early. However, many health system and structural challenges will have to be overcome for every person living with HIV in South Africa, and other developing economies, to experience the positive health outcomes related to starting treatment early.
Accessing treatment and staying on it for life present a very different reality to those people living with HIV in developed countries.
How Long Can You Live With Hiv Very
Roz Woodward for Photodisc via Thinkstock
Just this past week, I met John , a 50-year-old long-term survivor with HIV, in our clinic in Denver, Colorado. He was on a well-tolerated treatment regimen, had an undetectable viral load and normal CD4 count. He asked me about new studies on HIV treatments, and about both his projected quality and quantity of life.
I told him that, on average, life expectancy for people living with HIV — provided they get tested, find their way into a care center, initiate antiretroviral treatment and continue taking that treatment regularly — is similar to people who don’t have HIV infection.
He gave me a suspicious look. “Are you sure?” he asked.
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Bc Researchers Explore Life Expectancy Among Hiv
In the 20th century, life expectancy increased in Canada and other high-income countries thanks to improvements in medicine, better living conditions and so on. These changes have led some researchers to focus on something called health-adjusted life expectancy: exploring the number of years a person can expect to live in good and bad health and taking into account age-related illness, death and disability.
Among many HIV-positive people in Canada and other high-income countries there has been a very significant average increase in life expectancy since the introduction of potent combination anti-HIV therapy in 1996. However, some HIV-positive people, even if they use ART, will not have near-normal life expectancy because of problems largely unrelated to HIV infection, including the following:
- smoking
- unrecognized, untreated or poorly managed mental health issues
- co-infection with hepatitis B virus and/or hepatitis C virus
Mortality In The First Year Of Hiv Treatment
A total of 2,106 people died in the first year of starting ART and 2,302 people died during the 15,813 person-years included in the study.
People starting HIV treatment in later years were much less likely to die in the first year of treatment than people starting HIV treatment in earlier years . The increased availability of more effective and better tolerated HIV medications over time is likely to have contributed to this disparity, the authors said. Mortality in the first year of HIV treatment was strongly influenced by people starting treatment very late in their HIV infection .
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Life Expectancy Gap Closing For Americans Living With Hiv
Recent research has found that Americans living with HIV now have a similar life expectancy to those who do not have the virus.
Human immunodeficiency virus is a virus that attacks the bodys immune system and, without treatment, can lead to acquired immunodeficiency syndrome . Due to advances in treatment over the last several decades, people with HIV are living longer than ever. A study published in the Annals of Internal Medicine earlier this month found that Americans living with HIV now have a similar life expectancy to those without the virus. GlobalData epidemiologists expect an increase in the diagnosed prevalent cases of the disease over the next decade, but as people with the disease are living longer, prevalent cases could exceed those currently forecast.
Edwards and colleagues compared 82,766 adults entering clinical care at 13 US North American AIDS Cohort Collaboration on Research and Design sites between 1999 and 2017 to a subset of the US population matched on demographic factors, calendar time and county. People entering HIV care were overall more likely to die over the next five years, with mortality rates almost 8% higher compared to the US general population. The study authors, however, found that this gap in mortality narrowed over time from 11% to around 3% among those entering care between 19992004 and 20112017 respectively.
Related Report
Data Extraction And Management
The following characteristics were extracted from the research articles matching the inclusion criteria, and entered into a database by a single reviewer : study characteristics , characteristics of participants , life expectancy and standard error or 95% confidence intervals around life expectancy estimates at specific ages both overall and stratified by gender. Income region was classified according to World Bank Income categories, as low/middle income or high income .
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The Benefits Of Regular Care
Bear in mind that compared to HIV-negative people, many HIV-positive people in Canada and similar countries are under a relatively high degree of medical scrutinythey undergo visits to the clinic for interviews and laboratory tests several times each year. This degree of heightened medical surveillance is likely to detect any complications early on, before they can become serious. This is yet another factor that may help extend the lifespan of HIV-positive people.
In the next article, we explore trends in survival among HIV-positive people in countries with health care systems similar to Canada and issues that can be addressed to help prolong survival.
Sean R. Hosein
REFERENCE:
Samji H, Cescon A, Hogg RS, et al. Closing the Gap: Increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013 Dec 18 8:e81355.
How Is Life Expectancy Calculated
Life expectancy is the average number of years that a person can expect to live.
More precisely, it is the average number of years an individual of a given age is expected to live if current mortality rates continue to apply. It is an estimate that is calculated by looking at the current situation of a group of people and projecting that into the future.
However, HIV is a relatively new disease and HIV treatment is a rapidly changing area of medicine. It is therefore hard to know whether our current experience will be an accurate guide to the future.
At the moment, there are large numbers of people living with HIV in their twenties, thirties, forties, fifties and sixties. Current death rates are very low, resulting in encouraging figures for future life expectancy. But we have very little experience of people living with HIV in their seventies or eighties, so we know less about the impact HIV may have later in life.
Also, healthcare for people with HIV is likely to get better in the future. People living with HIV will benefit from improved anti-HIV drugs that have fewer side-effects, are easier to take and are more effective in suppressing HIV. Doctors understanding of how best to prevent and treat heart disease, diabetes, cancers and other conditions in people with HIV is improving. This could mean that people actually live longer than our current estimates suggest.
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No Longer A Death Sentence
This development is a consequence of the fact that HIV is no longer seen as a death sentence, and people with HIV now can live long and relatively healthy lives.
Their lifespan has increased dramatically with combination antiretroviral therapy, yet an 8- to 13-year gap in survival persists when compared to individuals without the virus, according to a Kaiser Permanente study published earlier this year in the Journal of Acquired Immune Deficiency Syndromes.
The study took place from 1996 to 2011, and looked at estimated life expectancy the average number of years of life remaining at age 20 in people with HIV and individuals who were not infected. It included nearly 25,000 HIV-infected adults, and more than 250,000 adults without the virus, who were matched for age, gender, medical center, and year. All individuals were Kaiser members.
The gap in life expectancy persists between people infected with HIV and individuals who are not, ranging from 8 to 13 years depending on when antiretroviral therapy is initiated, as well as demographics and risk factors.
Those figures differed somewhat from those in a 2013 study published in PLOS ONE.
It found that some men who have sex with men with HIV could expect to live as long as the average American 77 years though nonwhite patients still lagged far behind. The average person infected with HIV in North America could expect to live to the age of 63.
How Has Treatment Improved
Antiretroviral medications can help to slow damage caused by HIV infection and prevent it from developing into stage 3 HIV, or AIDS.
A healthcare provider will recommend undergoing antiretroviral therapy. This treatment requires taking three or more antiretroviral medications daily. The combination helps suppress the amount of HIV in the body . Pills that combine multiple medications are available.
The different classes of antiretroviral drugs include:
- non-nucleoside reverse transcriptase inhibitors
- integrase inhibitors
Viral-load suppression allows people with HIV to live healthy lives and decreases their chances of developing stage 3 HIV. The other benefit of an undetectable viral load is that it helps reduce transmission of HIV.
The 2014 European PARTNER study found that the risk of HIV transmission is very small when a person has an undetectable load. This means that the viral load is below 50 copies per milliliter .
This discovery has led to an HIV prevention strategy known as treatment as prevention. It promotes constant and consistent treatment as a way to reduce the spread of the virus.
HIV treatment has evolved tremendously since the onset of the epidemic, and advancements continued to be made. Initial reports from a clinical trial in the United Kingdom and a from the United States showed promising results in experimental HIV treatments that could put the virus into remission and boost immunity.
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Inclusion And Exclusion Criteria
Only studies with the following characteristics were included in the analysis. The studies were required to be cohort studies of HIV-positive people aged 14 years who were taking at least three drugs in combination. They had to have systematically reported life expectancy at age of starting cART using abridged life table estimation . Ascertainment of mortality data was through active patient follow-up at health facilities or medical records, or linkage with vital statistics registries. Studies that estimated life expectancy by survival analysis, mathematic modelling or other statistical methods or studies that reported life expectancy from a different time origin were excluded from this analysis. This ensured that the studies included used a consistent methodology to allow direct comparison of results. We also eliminated overlapping studies or duplicate cohorts, taking into account that high-income country studies were often collaborations including cohorts from many countries.
What Is The Life Expectancy For People Living With Hiv In The Uk
A study published in 2014 looked at the outcomes of over 20,000 adults who started HIV treatment in the UK, between 2000 and 2010. The analysis didnt include people who inject drugs, who tend to have poorer outcomes than other people, but otherwise included a wide range of adults living with HIV.
The key finding was that people who had a good initial response to HIV treatment had a better life expectancy than people in the general population.
Specifically, a 35-year-old man who had a CD4 cell count over 350 and an undetectable viral load one year after starting HIV treatment could expect to live to the age of 81. A 50-year-old man with the same results after one year of treatment was predicted to live to the age of 83. In the general population at this time, men in these age groups were expected to live to 77 and 78 years.
“A person living with HIV has a similar life expectancy to an HIV-negative person providing they are diagnosed in good time, have good access to medical care, and are able to adhere to their HIV treatment.”
A 35-year-old woman and a 50-year-old woman with the same results could expect to live to 83 and 85 years. This compares to 82 and 83 years in the general population.
A 35-year-old man with any of those results could expect to live to 70-72 years. A 50-year-old man was predicted to live to 75-77 years. Women of the same ages could expect to live around two years longer than the men.
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Americans Living With Hiv Could Have The Same Life Expectancy As Those Without: Study
Suicide rates, however, remain high.
Story at a glance
- There is no cure for HIV, which can lead to AIDS, but the virus can be controlled with medical care.
- A new study finds that the five-year mortality rate for people living with HIV is nearing that of the general population in the United States.
- At the same time, research shows that people living with HIV are at higher risk for suicide.
Since the HIV/AIDS pandemic exploded in the 1970s, no cure has been developed for the 1.2 million Americans living with the human immunodeficiency virus . But with todays medical care, their life expectancy could be the same as any other American, according to a new study.
“In the early days of the AIDS pandemic, getting a diagnosis with AIDS was incredibly bad news and the prognosis for survival was really poor, and that’s not true today,” lead author Jessie Edwards, a research assistant professor at the University of North Carolina at Chapel Hill, told HealthDay. “Someone diagnosed with HIV in this day and age can be linked to care and receive highly effective treatment and feel confident that their survival outlook is actually very good.”
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Factors Linked To Ill Health
In general, many of the drivers of ill health in HIV-positive people in this study were linked to complications arising from chronic kidney and liver injury. According to the researchers, these co-existing illnesses, or comorbidities, among HIV-positive people resulted in substantial ill health in the last few years of life.
Among HIV-negative people, the main cause of ill health stemmed from cardiovascular disease. Researchers found that a similar compression of illness occurred among HIV-negative people toward the end of their lives.
Other researchers in Baltimore, Maryland, have found that HIV-positive people who have a history of injecting street drugs are at heightened risk for kidney- and liver-related health problems. In this population, liver-related injury can arise because of co-infection with hepatitis B and/or C virus and kidney-related injury can arise as complication of hepatitis C virus co-infection. In Canada today, the most common way that these viruses are spread is from exposure to contaminated equipment used for injecting street drugs.
Indeed, the B.C. researchers stated that the substantial differences in health-adjusted life expectancy could be attributed to a history of injection drug use among HIV-positive people in this study.
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Early Art Improves Life Expectancy But Still A Long Way To Go
byGreg Laub, Director, Video, MedPage Today June 15, 2020
In a cohort study of 39,000 adults with HIV infection and 387,785 adults without HIV infection in the U.S., infected individuals lived 6.8 fewer years overall and 9.5 fewer years without major chronic comorbidities, even when antiretroviral therapy was begun at high CD4 cell counts.
, of Harvard Pilgrim Health Care Institute, originally reported the findings at the 2020 virtual Conference on Retroviruses and Opportunistic Infections . In this exclusive MedPage Today video, Marcus discusses the study results, which were also JAMA Network Open.
Following is a transcript of her remarks:
On the other hand, we saw a substantial gap in the number of healthy years lived without major chronic co-morbidities, with people with HIV living 16 fewer healthy years than people without HIV. The good news was that gap was narrower, if people with HIV started antiretroviral therapy early with high CD4 counts. And that gap was improving over time for some but not all with co-morbidities.
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Greg Laub joined MedPage Today in 2005 as Production Manager and led the launch of the video department in 2007. He is currently responsible for the website’s video production. Follow
What You Can Do
The most important things you can do to protect your health as you live with HIV are to take your ART as your doctor prescribes and to see your health care team regularly.
There are several other things you can do to stay healthy and keep your immune system working well:
- Eat healthy foods. A diet with plenty of nutrients will keep your energy up and help your immune system fight infections. It also helps your body absorb your medications.
- Get regular exercise: A fitness program will help you stay strong and will give you endurance. It also will give your mental health a boost and help you to manage stress.
- Donât smoke. If you have HIV, smoking doesnât just raise your chances of cancer, heart disease, stroke, and early death. It also makes you even more prone to mouth sores, which are a common problem for people with the virus. Worst of all, your ART doesnât work as well when you smoke, so make it a top goal to be smoke-free.
Conference on Retroviruses and Opportunistic Infections: âIncreased overall life expectancy but not comorbidity-free years for people with HIV.â
AIDSinfo: âHIV and Opportunistic Infections, Coinfections, and Conditions,â âSide Effects of HIV Medicines,” âHIV and Osteoporosis.”
“Jama: âComorbidities in Persons With HIV: The Lingering Challenge.â
Health and Quality of Life Outcomes: âMeasuring quality of life among people living with HIV: a systematic review of reviews.â
CDC: âHealthy Living with HIV.â
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