Life expectancy now considerably exceeds the average in some people with HIV in the US but depends on cd4 count and when art is started

PROF.DRRAM ,HIV/AIDS,SEX Diseases,Deaddiction & Hepatitis Expert 
profdrram@gmail.com,+917838059592,+919832025033,DELHI,INDIA
HIV/ AIDS,CANCER MODERN MEDICINES AVAILABLE AT CHEAP RATE.
FOLLOW ON FACE BOOK:www.facebook.com/ramkumar 
FOLLOW ON TWITTER:www.twitter.com/profdrram

Early treatment is key, but huge disparities still remain but depends also on cd4 count and when we start art.A study from the US has found that some groups of people with HIV, especially those treated before their CD4 count falls below 350 cells/mm3, now have life expectancies equal to or even higher than the US general population.

However, it also finds that life expectancy for some other groups – most notably women and non-white people – is still considerably below comparable members of the general population and that for people who inject drugs, life expectancy in the era of antiretroviral therapy (ART) has not improved at all.

A second study, which looked at death rates among both HIV-positive and HIV-negative members of two cohorts of people with or at risk of HIV, has found that the death rate from non-AIDS-defining illnesses among people with HIV who started ART above the 350 cells/mm3 threshold was not, and never has been, any higher than among comparable HIV-negative people.

In other words, the sole contributor to the increased mortality in people who started ART early was AIDS. This was not, however, the case for people who started ART later, who had raised mortality due to non-AIDS-related causes as well as due to AIDS.

Life expectancy in people on therapy, 2000-2007

The first study looked at death rates among, and then computed life expectancy for, 22,937 people with HIV in the US and Canada who started ART between the beginning of 2000 and the end of 2007. It compared their life expectancy at age 20 with the general population and noted how it had changed in the study’s eight years.

Life expectancy at age 20 in the US population is approximately 57 years in men (i.e. on average, and in the absence of further change, 50% will die by the age of 77) and 62 years in women (i.e. 50% chance of death by 82). In Canada, men can expect to live nearly three years longer than this and women just over two.

The study found that for the group as a whole and over the full eight years, the average life expectancy in people with HIV was just under 43 years, i.e. 50% will die by the age of 63 – 15 years earlier than men and 19 years earlier than women in the general US population.

However, there were huge disparities in life expectancies between different groups. Whereas people who inject drugs only had a life expectancy of 29 more years at age 20, for white people it was 52 years, for those starting treatment with a CD4 count above 350 cells/mm3 it was 55 years and for gay men it was 57 years – the same (or slightly higher) than in US men in general.

Furthermore, life expectancy had improved dramatically between 2000 and 2008 for most groups. In non-white people, even though life expectancy for those on ART between 2005 and 2007 was still only 48 more years at age 20 – i.e. nine years behind US men and 14 years behind US women – this was a dramatic improvement since 2000-2002 when non-white people on ART could expect, on average, to die at 50 – a gain of 18 years.

Life expectancy at age 20 had gone up 17 years in men, 10 years in women (though notably, this had not improved since 2005), by 13 years in gay men, by 12.5 years in heterosexual people, and by 20 years in those starting ART at CD4 counts over 350 cells/mm3.

This means that average life expectancy at age 20 was now equal to US men in the general population, among heterosexual people with HIV and in white people. It was also a remarkable 69 years at age 20 in gay men and people starting ART before 350 cells/mm3 – meaning that, if nothing else changed, these groups, as long as they stay on ART, have a 50/50 chance of seeing their 89th birthday – a full seven years longer than women in the general US population.

In contrast, life expectancy at age 20 in people who inject drugs had not changed at all and was still 29 years at age 20 in 2007, as it was in 2000.

Another sobering finding was that only 28% of the cohort had started ART before their CD4 count fell below 350 cells/mm3, though this proportion had improved over time.