HIV patients with optimal care living as long as non-HIV peers

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Patients with HIV who receive optimal care are now expected to live as long as their peers without HIV, Healio reports that this is according to recent study results from Denmark. “In 2007, we and others reported encouraging survival estimates for persons receiving HIV care in the Danish HIV Cohort Study,” Dr Nicolai Lohse and Dr Niels Obel, both from Copenhagen University, wrote. “We estimated that 25-year-old persons with HIV infection not co-infected with hepatitis C virus would survive to a median age of 63.9 years. Despite these encouraging findings, median survival was still 12.2 years short of that observed in a sex- and age-matched sample of persons from the general population.”

To update their 2007 report, Lohse and Obel evaluated 5,701 patients with HIV, without HCV co-infection, and 28,505 controls matched for age and sex. They utilised the same methods from their 2007 study. Most participants were men (77%), and the median age at study entry was 37.1 years (interquartile range, 30.5 to 45.5 years).

Overall, the median age at death for a patient with HIV aged 25 years has increased over the past 20 years from 34.5 years (95% CI, 32.2- 35.9) in 1995-1996 to 52.2 years (95% CI, 49-57.5) in 1997-1999, 62.8 years (95% CI, 60.4- 64.9) in 2000-2004, 66.8 years (95% CI, 65.7-68.5) in 2005-2009, and 73.9 years (95% CI, 72.2-76.7) in 2010-2015, compared with 80 years (95% CI, 79.4-80.8 years) for the general population.

According to the researchers, these results correlate with those from multiple studies around the world. They noted that lifestyle factors not necessarily related to the infection are the main barriers to a long life for patients with HIV and access to care.

“We believe that the main drivers of this success are the continuous advent of new drug classes, better management of comorbidity, stronger focus on lifestyle-related risk factors, and more effective HIV detection leading to earlier presentation for care,” Lohse and Obel wrote.

“Despite these advances, many persons with HIV infection globally lack access to care and treatment and many others are not reaping the possible benefits even when they do have access,” they concluded. “We should address these limitations because this report and others like it document the benefits we can expect with a strong focus on timely diagnosis, integrated solutions, and new therapies.”

Abstract 1
Background: In 2007, we and others reported encouraging survival estimates for persons receiving HIV care in the Danish HIV Cohort Study (1). We estimated that 25-year-old persons with HIV infection not co-infected with hepatitis C virus would survive to a median age of 63.9 years. Despite these encouraging findings, median survival was still 12.2 years short of that observed in a sex- and age-matched sample of persons from the general population.
Objective: To update the analyses we reported in 2007.
Methods and Findings: We estimated survival for persons receiving HIV care up to 2015 using the same methods that we used in 2007 (1). We estimated median survival for persons aged 25 years in 5 periods: 1995 to 1996, 1997 to 1999, 2000 to 2004, 2005 to 2009, and 2010 to 2015. Each person with HIV infection who was not co-infected with HCV was matched with 5 persons from the general population on the basis of sex and age at the date of HIV diagnosis. The study included 5701 persons with HIV infection and 28 505 matched control participants, yielding 60 270 person-years of observation for persons with HIV infection and 365 713 person-years of observation for control participants. Fewer than 1% of persons were lost to follow-up. The study comprised 77% men at a median age at study entry of 37.1 years (interquartile range, 30.5 to 45.5 years). The estimated median age of death for a 25-year-old HIV-infected person increased from 34.5 years (95% CI, 32.2 to 35.9 years) in 1995 to 1996 to 52.2 years (CI, 49.0 to 57.5 years) in 1997 to 1999, 62.8 years (CI, 60.4 to 64.9 years) in 2000 to 2004, 66.8 years (CI, 65.7 to 68.5 years) in 2005 to 2009, and 73.9 years (CI, 72.2 to 76.7 years) in 2010 to 2015. These estimates were compared with a life expectancy of 80.0 years (CI, 79.4 to 80.8 years) for persons from the general population (Figure). Apart from excluding the 9.7% of persons with HIV infection co-infected with hepatitis C virus, our estimates are based on all persons diagnosed with HIV infection in Denmark.

Authors
Nicolai Lohse; Niels Obel

Abstract 2
Knowing the expected survival of HIV-infected patients is of major public health interest. Mortality rates have decreased substantially in recent years as a result of improved effectiveness of highly active antiretroviral therapy (HAART) (1). Studies comparing mortality rates for HIV-infected persons with age- and sex-specific mortality rates for the general population (2–5) have reported 3- to 10-fold increase in successfully treated patients. The relative mortality rate, however, is highly dependent on the age distribution of the study sample and does not in itself answer questions about survival. We therefore aimed to estimate median survival and age-specific mortality rates for an entire HIV-infected population compared with a cohort from the general population. Persons with HIV infection were followed from before initiation of HAART and included those with such predictors of lower survival as poor response to therapy, AIDS diagnosis, low CD4 count, high viral load, and poor adherence to treatment (6, 7). Linking data from the population-based Danish HIV Cohort Study (DHCS) (8) and the Danish Civil Registration System (CRS) (9, 10) allowed us to use product-limit methods that are analogous to the period life tables used by national authorities for estimating median survival (11).

Authors
Nicolai Lohse; Ann-Brit Eg Hansen; Gitte Pedersen; Gitte Kronborg; Jan Gerstoft; Henrik Toft Sørensen; Michael Væth; Niels Obel

Healio report
Annals of Internal Medicine letter abstract
Annals of Internal Medicine 2007 study abstract


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