Do people with HIV infection have a normal life expectancy in the era of combination antiretroviral therapy?

BMC Medicine

Caroline A Sabin¹ 

[1] Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK

关键词: Mortality;    Trends;    Life expectancy;    Combination antiretroviral therapy;    Human immunodeficiency virus;   

Others  :  855320
DOI  :  10.1186/1741-7015-11-251

 received in 2013-10-10, accepted in 2013-10-30,  发布年份 2013

【 摘 要 】

There is evidence that the life expectancy (LE) of individuals infected with the human immunodeficiency virus (HIV) has increased since the introduction of combination antiretroviral therapy (cART). However, mortality rates in recent years in HIV-positive individuals appear to have remained higher than would be expected based on rates seen in the general population. A low CD4 count, whether due to late HIV diagnosis, late initiation of cART, or incomplete adherence to cART, remains the dominant predictor of LE, and thus the individual’s disease stage at initiation of cART (or thereafter) certainly contributes to these higher mortality rates. However, individuals with HIV also tend to exhibit lifestyles and behaviors that place them at increased risk of mortality, particularly from non-AIDS causes. Thus, although mortality rates among the HIV population may indeed remain slightly higher than those seen in the general population, they may be no higher than those seen in a more appropriately matched control group. Thus, further improvements in LE may now only be possible if some of the other underlying issues (for example, modification of lifestyle or behavioral factors) are tackled.

【 授权许可】

   
2013 Sabin; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Joint United Nations Programme on HIV/AIDS (UNAIDS). AIDSInfo. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/ webcite
• [2]Porter K, Johnson AM, Phillips AN, Darbyshire JH: The practical significance of potential biases in estimates of the AIDS incubation period distribution in the UK Register of HIV Seroconverters. AIDS 1999, 13:1943-1951.
• [3]Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d’Arminio Monforte A, Knysz B, Dietrich M, Phillips AN, Lundgren JD: Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet 2003, 362:22-29.
• [4]Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998, 338:853-860.
• [5]Bansi L, Sabin C, Delpech V, Hill T, Fisher M, Walsh J, Chadborn T, Easterbrook P, Gilson R, Johnson M, Porter K, Anderson J, Gompels M, Leen C, Ainsworth J, Orkin C, Nelson M, Rice B, Phillips A: Trends over calendar time in antiretroviral treatment success and failure in HIV clinic populations. HIV Med 2010, 11:432-438.
• [6]Lampe FC, Smith CJ, Madge S, Kinloch-de Loes S, Tyrer M, Sabin CA, Chaloner C, Youle M, Johnson MA, Phillips AN: Success of clinical care for human immunodeficiency virus infection according to demographic group among sexually infected patients in a routine clinic population, 1999 to 2004. Arch Int Med 2007, 167:692-700.
• [7]May MT, Ingle SM: Life expectancy of HIV-positive adults: a review. Sex Health 2011, 8:526-533.
• [8]Nakagawa F, Lodwick RK, Smith CJ, Smith R, Cambiano V, Lundgren JD, Delpech V, Phillips AN: Projected life expectancy of people with HIV according to timing of diagnosis. AIDS 2012, 26:335-343.
• [9]The Antiretroviral Therapy Cohort Collaboration: Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008, 372:293-299.
• [10]Johnson LF, Mossong J, Dorrington RE, Schomaker M, Hoffmann CJ, Keiser O, Fox MP, Wood R, Prozesky H, Giddy J, Belen Garone D, Cornell M, Egger M, Boulle A: Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med 2013, 10:e1001418.
• [11]Mills EJ, Bakanda C, Birungi J, Chan K, Ford N, Cooper CL, Nachega JB, Dybul M, Hogg RS: Life expectancy of persons receiving antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Int Med 2011, 155:209-216.
• [12]Losina E, Schackman BR, Sadownik SN, Gebo KA, Walensky RP, Chiosi JJ, Weinstein MC, Hicks PL, Aaronson WH, Moore RD, Paltiel AD, Freedberg KA: Racial and sex disparities in life expectancy losses among HIV-infected persons in the United States: impact of risk behaviour, late initiation, and early discontinuation of antiretroviral therapy. Clin Infect Dis 2009, 49:1570-1578.
• [13]Fang CT, Chang YY, Hsu HM, Twu SJ, Chen KT, Lin CC, Huang LYL, Chen MY, Hwang JS, Wang JK, Chuang DY: Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy. Q J Med 2007, 100:97-105.
• [14]Aragon TJ, Lichtensztajn DY, Katcher BS, Reiter R, Katz MH: Calculating expected years of life lost for assessing local ethnic disparities in causes of premature death. BMC Pub Health 2008, 8:116. BioMed Central Full Text
• [15]Wang GD, Lai DJ, Burau KD, Du XL: Potential gains in life expectancy from reducing heart disease, cancer, Alzheimer’s disease, kidney disease or HIV/AIDS as major causes of death in the USA. Pub Health 2013, 127:348-356.
• [16]Lai DJ, Tarwater PM, Hardy RJ: Measuring the impact of HIV/AIDS, heart disease and malignant neoplasms on life expectancy in the USA from 1987 to 2000. Pub Health 2006, 120:486-492.
• [17]Bor J, Herbst AJ, Newell M-L, Barnighausen T: Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science 2013, 339:961-965.
• [18]Bhaskaran K, Hamouda O, Sannes M, Boufassa F, Johnson AM, Lambert PC, Porter K: Changes in the risk of death after HIV seroconversion compared with mortality in the general population. JAMA 2008, 300:51-59.
• [19]French AL, Sawel SH, Hershow R, Benning L, Hessol NA, Levine AM, Anastos K, Augenbraun M, Cohen MH: Trends in mortality and causes of death among women with HIV in the United States: a 10-year study. J Acquir Imm Defic Syndr 2009, 51:399-406.
• [20]Lewden C, Bouteloup V, De Wit S, Sabin C, Mocroft A, Wasmuth JC, van Sighem A, Kirk O, Obel N, Panos G, Ghosn J, Dabis F, Mary-Krause M, Leport C, Perez-Hoyos S, Sobrino-Vegas P, Stephan C, Castagna A, Antinori A, d’Arminio Monforte A, Torti C, Mussini C, Isern V, Calmy A, Teira R, Egger M, Grarup J, Chene G: All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population: evidence from a large European observational cohort collaboration. Int J Epidemiol 2012, 41:433-445.
• [21]Lohse N, Hansen AB, Pedersen G, Kronborg G, Gerstoft J, Sorensen HT, Vaeth M, Obel N: Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 2007, 146:87-95.
• [22]Puhan MA, Van Natta ML, Palella FJ, Addessi A, Meinert C: Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors. Clin Infect Dis 2010, 51:947-956.
• [23]May M, Gompels M, Delpech V, Porter K, Post F, Johnson M, Dunn D, Palfreeman A, Gilson R, Gazzard B, Hill T, Walsh J, Fisher M, Orkin C, Ainsworth J, Bansi L, Phillips A, Leen C, Nelson M, Anderson J, Sabin C: Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. Brit Med J 2011, 343:d6016.
• [24]The Antiretroviral Therapy Cohort Collaboration: Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries. Int J Epidemiol 2009, 38:1624-1633.
• [25]McManus H, O’Connor CC, Boyd M, Broom J, Russell D, Watson K, Roth N, Read PJ, Petoumenos K, Law MG: Long-term survival in HIV positive patients with up to 15 years of antiretroviral therapy. PLoS ONE 2012, 7:e48839.
• [26]Cockerham L, Scherzer R, Zolopa A, Rimland D, Lewis CE, Bacchetti P, Grunfeld C, Shlipak M, Tien PC: Association of HIV infection, demographic and cardiovascular risk factors with all-cause mortality in the recent HAART era. J Acquir Imm Defic Syndr 2010, 53:102-106.
• [27]Galvan FH, Bing EG, Fleishman JA, London AS, Caetano R, Burnam MA, Longshore D, Morton SC, Orlando M, Shapiro M: The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study. J Study Alcohol 2002, 63:179-186.
• [28]Friis-Møller N, Weber R, Reiss P, Thiébaut R, Kirk O, d’Arminio Monforte A, Pradier C, Morfeldt L, Mateu S, Law M, El-Sadr W, De Wit S, Sabin CA, Phillips AN, Lundgren JD: Cardiovascular disease risk factors in HIV patients–association with antiretroviral therapy. Results from the DAD study. AIDS 2003, 17:1179-1193.
• [29]Mimiaga MJ, Reisner SL, Grasso C, Crane HM, Safren SA, Kitahata MM, Schumacher JE, Mathews WC, Mayer KH: Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. Am J Pub Health 2013, 103:1457-1467.
• [30]Health Protection Agency: HIV in the United Kingdom: 2012 Report. London: Health Protection Services, Colindale; 2012.
• [31]Helleberg M, Afzal S, Kronborg G, Larsen CS, Pedersen G, Pedersen C, Gerstoft J, Nordestgaard BG, Obel N: Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis 2013, 56:727-734.
• [32]Helleberg M, Kronborg G, Larsen CS, Pedersen G, Pedersen C, Gerstoft J, Obel N: Causes of death among Danish HIV patients compared with population controls in the period 1995–2008. Infection 2012, 40:627-637.
• [33]Wada N, Jacobson LP, Cohen M, French A, Phair J, Munoz A: Cause-specific life expectancies after 35 years of age for human immunodeficiency syndrome-infected and human immunodeficiency syndrome-negative individuals followed simultaneously in long-term cohort studies, 1984–2008. Am J Epidemiol 2013, 177:116-125.
• [34]Mugavero MJ, Lin H-Y, Willig JH, Westfall AO, Ulett KB, Routman JS, Abroms S, Raper JL, Saag MS, Allison JJ: Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis 2009, 48:248-256.
• [35]Druyts EF, Rachlis BS, Lima VD, Harvard SS, Zhang W, Brandson EK, Strathdee SA, Montaner JSG, Hogg RS: Mortality is influenced by locality in a major HIV/AIDS epidemic. HIV Med 2009, 10:274-281.
• [36]Lohse N, Gerstoft J, Kronborg G, Larsen CS, Pedersen C, Pedersen G, Nielsen L, Sorensen HT, Obel N: Comorbidity acquired before HIV diagnosis and mortality in persons infected and uninfected with HIV: a Danish population-based cohort study. JAIDS 2011, 57:334-339.
• [37]Waters L, Sabin CA: Late HIV presentation: epidemiology, clinical implications and management. Expert Rev Anti Infect Ther 2011, 9:877-889.
• [38]Chadborn TR, Baster K, Delpech VC, Sabin CA, Sinka K, Rice BD, Evans BG: No time to wait: how many HIV-infected homosexual men are diagnosed late and consequently die? (England and Wales, 1993–2002). AIDS 2005, 19:513-520.
• [39]Grangeiro A, Escuder MM, Menezes PR, Alencar R, de Castilho EA: Late entry into HIV care: estimated impact on AIDS mortality rates in Brazil, 2003–2006. PLoS ONE 2011, 6:e14585.
• [40]Chadborn TR, Delpech VC, Sabin CA, Sinka K, Evans BG: The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000–2004). AIDS 2006, 20:2371-2379.
• [41]van Sighem A, Gras L, Reiss P, Brinkman K, de Wolf F: Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals. AIDS 2010, 24:1527-1535.
• [42]Fidler S, Porter K, Ewings F, Frater J, Ramjee G, Cooper D, Rees H, Fisher M, Schechter M, Kaleebu P, Tambussi G, Kinloch S, Miro JM, Kelleher A, McClure M, Kaye S, Gabriel M, Phillips R, Weber J, Babiker A: Short-course antiretroviral therapy in primary HIV infection. N Engl J Med 2013, 368:207-217.
• [43]Office for National Statistics: Statistics Bulletin: Life expectancy at birth and at age 65 for health areas in the United Kingdom, 2003–05 and 2007–09. http://www.ons.gov.uk/ons/publications/index.html?pageSize=50&sortBy=none&sortDirection=none&newquery=life+expectancy&content-type=publicationContentTypes webcite
• [44]Lewden C, Gabillard D, Minga A, Ekouevi DK, Avit D, Konate I, Amani-Bosse C, Messou E, Coffie P, Ouedraogo A, Laurent C, Anglaret X: CD4-specific mortality rates among HIV-infected adults with high CD4 counts and no antiretroviral treatment in West Africa. J Acquir Imm Defic Syndr 2012, 59:213-219.
• [45]Verguet S, Lim SS, Murray CJL, Gakidou E, Salomon JA: Incorporating loss to follow-u p in estimates of survival among HIV-infected individuals in sub-Saharan Africa enrolled in antiretroviral therapy programs. J Infect Dis 2013, 207:72-79.
• [46]May MT, Hogg RS, Justice AC, Shepherd BE, Costagliola D, Ledergerber B, Thiebaut R, Gill MJ, Kirk O, van Sighem A, Saag MS, Navarro G, Sobrino-Vegas P, Lampe F, Ingle S, Guest JL, Crane HM, d’Arminio Monforte A, Vehreschild JJ, Sterne JAC: Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics. Int J Epidemiol 2012, 41:1807-1820.