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.
Can We Improve Le Further
Late HIV diagnosis remains extremely common in many countries , and has been reported to be a major risk factor for mortality . In Brazil, it was estimated that 95.5% of deaths occurring in the first year after diagnosis were attributable to late diagnosis study investigators estimated that averting late diagnosis would have reduced the AIDS mortality rate 2003 to 2006 by 39.5%, a similar reduction to that produced by cART. In the UK, earlier diagnosis would have reduced short-term mortality by 84% in MSM and by 56% in those infected heterosexually . Using the HIV Synthesis model, a stochastic computer simulation model of HIV progression, Nakagawa showed that LE from birth was 71.5 years, with 10.5 years lost to HIV infection, in a scenario in which diagnosis occurred at a late stage of HIV infection , but under a scenario of earlier diagnosis , LE from birth was 75.0 years, with only 7.0 years lost, on average, due to HIV. Thus, earlier diagnosis of HIV might go some way to improve LE further.
Life Expectancy Vs Maximum Life Span
Life expectancy is commonly confused with the average age an adult could expect to live. This confusion may create the expectation that an adult would be unlikely to exceed an average life expectancy, even though, with all statistical probability, an adult, who has already avoided many statistical causes of adolescent mortality, should be expected to outlive the average life expectancy calculated from birth. One must compare the life expectancy of the period after childhood, to estimate also the life expectancy of an adult. Life expectancy can change dramatically after childhood, even in preindustrial times as is demonstrated by the Roman Life Expectancy table, which estimates life expectancy to be 25 years at birth, but 53 years upon reaching age 25. Studies like Plymouth Plantation “Dead at Forty” and Life Expectancy by Age, 18502004 similarly show a dramatic increase in life expectancy once adulthood was reached.
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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.
Improving Life Expectancy For Hiv Positive People
Research showed that antiretroviral treatment dramatically increases life expectancy and should be started as early as possible, leading to a major change of approach by policy makers, clinicians and insurers across the world.
In 2002, the Antiretroviral Therapy Cohort Collaboration – a Bristol-led initiative involving 19 cohort studies from across Europe and North America – investigated rates of AIDS and death in more than 12,000 HIV positive patients treated in high income countries.
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What Is The Last Stage Of Hiv Infection
Acquired immune deficiency syndrome is the final and most severe stage of HIV infection. Because HIV has severely damaged the immune system, the body can’t fight off opportunistic infections.
- If ART is not given, HIV infection usually advances to AIDS in 10 years or longer. In some people, however, it may advance faster.
- In this stage, HIV reduces CD4 cell counts to very low levels which severely damages the immune system.
- The week immune system cannot fight even those bacteria, viruses, and fungi which are unable to cause disease in other healthy people . Opportunistic infections are infections and infection-related cancers that occur more frequently or are more severe in people with weakened immune systems than in people with healthy immune systems.
- Once a person progresses to AIDS, they have a high viral load and can transmit HIV to others very easily.
- In the absence of treatment, people with AIDS typically survive for about three years.
Growing Older With Hiv
Today, thanks to improvements in the effectiveness of treatment with HIV medicine , people with HIV who are diagnosed early and who get and stay on ART can keep the virus suppressed and live long and healthy lives. For this reason, nearly half of people living with diagnosed HIV in the United States are aged 50 and older. Many of them have been living with HIV for many years others were diagnosed with HIV later in life.
Thats a significant change from the early years of the epidemic when people who were diagnosed with HIV or AIDS could expect to live only 1-2 years after their diagnosis. This meant that the issues of aging were not a major focus for people with HIV disease.
According to the Centers for Disease Control and Prevention , in 2018, over half of people in the United States and dependent areas with diagnosed HIV were aged 50 and older. In addition, people aged 50 and older accounted for 17% of the 37,968 new HIV diagnoses in 2018 in the United States and dependent areas. Though new HIV diagnoses are declining among people aged 50 and older, around 1 in 6 HIV diagnoses in 2018 were in this group.
People over age 50 with HIV make up 46.8% of the over half a million clients served by the Ryan White HIV/AIDS Program . In 2019, 92.2% of clients aged 50 and older receiving RWHAP HIV medical care were virally suppressed, which was higher than the national RWHAP average .
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How Does Hiv Affect A Person In The Long Term
Though the outlook has gotten much better for those with HIV, there are still some long-term effects that they might experience.
As time passes, people living with HIV may begin to develop certain side effects of treatment or HIV itself.
These may include:
The body may also undergo a shift in how it processes sugars and fats. This can lead to having more fat in certain areas of the body, which can change the bodys shape. However, these physical symptoms are more common with older HIV medications. Newer treatments have far fewer, if any, of these symptoms affecting physical appearance.
If treated poorly or left untreated, HIV infection can develop into stage 3 HIV, or AIDS.
A person develops stage 3 HIV when their immune system is too weak to defend their body against infections. A healthcare provider will likely diagnose stage 3 HIV if the number of certain white blood cells in an HIV-positive persons immune system drops below 200 cells per mL of blood.
Life expectancy is different for every person living with stage 3 HIV. Some people may die within months of this diagnosis, but the majority can live fairly healthy lives with regular antiretroviral therapy.
The Takeaway: Great News But Also A Reminder Of Our Current Challenges
Taken as a whole, these encouraging life expectancy findings show that, for people with access to quality health care who begin HIV treatment early, a normal life span isnt just possibleits quite likely. Our results are likely generalizable to the broader insured population, Marcus noted.
However, even within this cohort of members of a major U.S. health care organization, only 29% had a CD4 count of 500 or higher when they started antiretroviral therapy. That will temper the rosy message somewhat, although theres still good news in the overall shrinking of the life-expectancy gap to under a decade between people living with HIV and HIV-negative people. The need for improvements in access to and retention in HIV care are clear.
In addition, the size and persistence of the gaps we see in comorbidity-free years provide a stark reminder about the work researchers and health care providers have ahead of them in adequately preventing, diagnosing, and managing significant health complications in people who are living with HIV. We are solidly in an era in which an HIV diagnosis no longer has to mean a shorter life the challenge we now face is to also ensure that an HIV diagnosis doesnt mean a less-healthy life.
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Study Construction: A : 10 Comparison Of Americans Receiving Health Care
In total, 39,000 HIV-positive Kaiser Permanente members age 21 or older were matched with 387,767 HIV-negative members of similar age, sex, and race. The average age of the entire cohort was 41 although there was racial diversity , participants were mostly male , and no data were available regarding transgender identification. Risk demographics loosely resembled those of the current U.S. epidemic, with 70% of the cohort identifying as men who have sex with men, 20% as heterosexual, and 8% as people who inject drugs.
In analyzing morbidity and mortality data, Marcus et al sought to answer two questions:
Calculating Life Expectancy With Hiv Or Aids
Recent research shows that a young person with HIV or AIDS could potentially live almost as long as anyone else in the general population. But this is only the case if they have routine access to health care and respond well to modern antiretroviral treatments . So a 20-year-old who starts on ARTs today, for example, might eventually live to be 67.
Keep in mind though, since there is no known cure, HIV life expectancy varies greatly from one individual to the next based on many things. This includes early detection plus, gender and lifestyle choices such as alcohol, tobacco, or drug use.
Over the past two decades, HIV life expectancy has drastically risen. What was once considered a terminal illness is now a medically manageable condition at any age. Those who abuse intravenous drugs or possess a preexisting immune disorder, however, do not fare as well.
In light of huge disparities in access to health care and ARTs, the CDC regularly publishes reports on obstacles to HIV and AIDS treatment. By 2016, it was estimated that 1.1 million people in the U.S., aged 13 or older, had HIV .
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Hiv Care Saves Lives Infographic
Viral suppression is the goal of HIV medical care. There are four key steps:
Step 1: HIV testing and diagnosis.
- About 14% of people living with HIV have never been diagnosed.
- Everyone needs to be tested to find out if they have HIV so they can start getting the medical care needed for viral suppression and reduce their risk of transmitting the virus to others.
Step 2: Getting and keeping people living with HIV in medical care.
- Only 40% of people living with HIV have received regular HIV medical care.
- Once in medical care, people can get HIV medicines and prevention services to help them stay healthy and protect their partners.
- Doctors, nurses, and other health care providers can use strategies, such as appointment reminders, to help patients stay in care.
Step 3: Prescribing HIV medicines.
- Only 37% of people living with HIV are prescribed HIV medicines. Too many have not been diagnosed or are not in HIV medical care.
- However, of patients in HIV medical care, 92% are prescribed HIV medicines.
- Doctors, nurses, and other health care providers should prescribe HIV medicines to everyone with HIV to lower the amount of virus in the body.
Step 4: Helping patients achieve viral suppression.
HIV care Continuum Shows Where Improvements are NeededOf the 1.2 million people living with HIV, 86% are diagnosed, 40% are engaged in care, 37% are prescribed antiretroviral medicines, and 30% are virally suppressed.
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Study Findings: Large Improvements In Lifespan But Large Differences In Comorbidity
The answer to the life expectancy question was an unambiguous yes: People living with HIV in the U.S. continue to close the lifespan gap with the HIV-negative population. Specifically, within this cohort of people age 21 or older:
Overall life expectancy for people living with HIV improved from 71 in the 2008-2010 period to 77 in the 2014-2016 period.
By comparison, life expectancy for HIV-negative people was 86 in the 2014-2016 period, shrinking the HIV status lifespan gap to 9 years.
Among people who started HIV treatment with a CD4 count of 500 or higher, life expectancy in the 2011-2016 period was 87, compared to 85 for HIV-negative people.
In the 2011-2016 period, people who started HIV treatment at that higher CD4 count lived an average of 11 years longer relative to the overall HIV-positive cohort.
The answer to the comorbidity question was more complexand more sobering. Marcus et al focused their analyses on six categories of incident health complications:
- chronic lung disease
They found that, in the 2014-2016 period, people living with HIV developed their first comorbidity at age 36, on average16 years earlier than HIV-negative people. The 16-year gap was the same in this more recent period as it was in the 2000-2003 period, although the age of first comorbidity incidence increased for both HIV-positive and HIV-negative people in the intervening years.
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Logit Survival Ratio Extrapolation
The survival ratio between the survival functions of two populations is defined by the formula: W = S / S . Because the patient population has a worse survival than the reference population, the value of W initially equals 1âat time point t = 0, then gradually decreases due to disease-associated excess mortality. Because the value of W is limited to the range from 0 to 1, linear regression for temporal trend is not applicable. We therefore used the logit transformation of W , or log. A higher logit W value corresponds to a higher W value, but the range of values was transformed from 0 â¼ 1 to that of ââ â¼ +â. Furthermore, if the HIV-associated excess hazard remains constant over time, the curve of the logit of W will converge to a straight line, as shown below.
HHHSSSSSttttWtW T sWW T s T f N tt T f
To facilitate the computation, we developed a software program MC-QAS, which was built in the R and S-PLUS 2000 environment and can be freely downloaded from .
What The Current Research Says
At the time of the introduction of highly active antiretroviral therapy in 1996, the average life expectancy of a 20-year-old newly infected with HIV was 10 years. With a new generation of drugs that are not only safer but more effective, those numbers have leaped significantly.
According to research from the longstanding North American AIDS Cohort Collaboration on Research and Design , a 20-year-old started on HIV therapy today can expect to live into their early 70s.
With the life expectancy of the general U.S. population hovering around 77 years, this means that people treated early for HIV can enjoy near-normal life expectancies. Some can expect to do much better.
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Hiv Life Expectancy: How Long Can You Live With Hiv Or Aids
The most frequently asked question for HIV-positive patients is how long can you live with HIV? Fortunately, the answer is far more promising than it was 20 years ago. Join Flo as we discuss how advancements in medical technology have altered the prognosis for those living with HIV or AIDS.
A national database containing statistics from 25 states shows that the average HIV life expectancy has more than doubled between 1996 and 2005. The bump from 10.5 to 22.5 years after diagnosis can be attributed to vast improvements in drug therapy and related approaches. However, experts still say this is only an average, and plenty of other circumstances must be taken into account regarding HIV life expectancy.