Study: HIV-Positive Life Expectancy Rises More Than 10 Years
HIV-positive individuals are now living a decade longer, according to a new study published in the journal The Lancet HIV.
The study found that 20-year olds who began antiretroviral therapy in 2010 are predicted to live up to ten years longer than those who first underwent similar treatment in 1996, the year it first became widely available.
A 20-year old infected with HIV today can expect to live to about age 78, almost as long as people without the disease, in part due to fewer side effects and less toxicity from current HIV therapy, according to the researchers of the study. There are also now greater options for patients who are infected with drug-resistant HIV strains.
"Our research illustrates a success story of how improved HIV treatments coupled with screening, prevention and treatment of health problems associated with HIV infection can extend the life span of people diagnosed with HIV," says Adam Trickey, medical statistician at the University of Bristol, who was involved with the study.
The UK researchers, as part of the international Antiretroviral Therapy Cohort Collaboration, analyzed data from more than 88,500 people with HIV from 18 European and North American studies. They found that much fewer people died in their first three years of treatment between the years 2008 and 2010 than those who started treatment between 1996 and 2007.
One reason for the increase in life expectancy is due to better adherence to antiretroviral therapy. While the earliest version of HIV therapies involved dozens of pills taken at different times of the day, current antiretroviral regimens include only a single pill containing a combination of medications taken once a day, which increases adherence and the likelihood that more people will take the drug daily.
"Combination antiretroviral therapy has been used to treat HIV for 20 years, but newer drugs have fewer side effects, involve taking fewer pills, are able to better prevent replication of the virus, and decrease virus resistance,” says Trickey.
Another reason for the increase in life expectancy is that people are beginning treatment earlier rather than later, which has shown to improve overall health outcomes.
In the past, the World Health Organization (WHO) recommended that people began treatment based on their CD4 count, suggesting they wait until the virus compromised their immune systems. However, the new recommendation calls for immediate treatment as soon as someone is diagnosed as HIV-positive.
Another reason for the increase in lifespan is due to overall better healthcare for HIV patients, according to the researchers. Because antiretroviral therapy has enabled HIV-positive individuals to keep their infections under control, doctors are now able to focus more on treating their other illnesses, such as heart disease, cancer and diabetes which tend to increase with age. By addressing these other concerns, patients are able to live longer.
However, further efforts are needed if life expectancy of HIV individuals is to match that of the general population, according to Trickey. Life expectancy in the UK and Canada was 81 in 2014 and almost 79 in the United States, according to the World Bank.
The gains in life expectancy have not been distributed in all subgroups of the HIV-positive population. Drug users, for example, show slower improvements in life expectancy, in part, because they have less access to healthcare and antiretroviral therapy.
"In drug users we must promote therapy and improve access to therapy to treat addictions as well as increasing access to hepatitis C treatment for people with both infections," Trickey said. "Although most people are likely to start treatment soon after diagnosis of HIV, this will only result in improved survival overall if the problems of late diagnosis and treatment access are addressed."
According to Trickey, the improvements in life expectancy prove that the current existing HIV therapies work. Therefore, extending lives even further doesn’t require the discovery of new drugs but better distribution of the ones already available.
Many people around the world are still unable to access the treatment they need. In 2015, almost 37 million people were living with HIV and only about 17 million people were receiving antiretroviral therapy, according to figures published by UNAIDS.
"Overall, the study reflects huge progress in diagnosis and management over the past 20 years,” says Jimmy Whitworth, professor of international health at the London School of Hygiene and Tropical Medicine.
“But I think it's important to recognize the global aspect here. Africa has the heaviest burden of the disease where this is a challenge of early diagnosis and treatment. The other issue is combating HIV in Russia and Ukraine, which is rising at frightening rates. Those are the places doing the least well."