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INCREASED OVERALL LIFE EXPECTANCY BUT NOT COMORBIDITY-FREE YEARS FOR PEOPLE WITH HIV
Julia L. Marcus1, Wendy Leyden2, Alexandra N. Anderson2, Rulin Hechter3, Michael A. Horberg4, Haihong Hu4, Jennifer O. Lam2, William J. Towner3, Qing Yuan3,
1Harvard Medical School, Boston, MA, USA,2Kaiser Permanente Division of Research, Oakland, CA, USA,3Kaiser Permanente Southern California, Pasadena, CA, USA,4Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
Combination antiretroviral therapy (ART) has dramatically improved life expectancy for people with HIV (PWH), but recent data comparing overall lifespan and comorbidity-free years by HIV status are lacking.
We conducted a cohort study of adult (aged ≥21) members of Kaiser Permanente in Northern or Southern California, or Mid-Atlantic States (DC, MD, VA), during 2000-2016. PWH were frequency-matched 1:10 to uninfected adults on age (2-year groups), sex, race/ethnicity, medical center, and calendar year. We used abridged life tables to estimate the average number of total and comorbidity-free years of life remaining at age 21 by calendar era. Comorbidity-free years were prior to diagnosis of any of 6 common comorbidities: cardiovascular disease, respiratory disease, renal disease, liver disease, cancer, or diabetes. For 2014-2016, we also estimated life expectancy for PWH with early ART initiation (i.e., with CD4 ≥500).
Among 39,000 PWH and 387,785 matched uninfected adults, there were 2,661 and 9,147 deaths, with mortality rates of 1,303 and 390 per 100,000 person-years, respectively. In 2000-2003, overall life expectancy at age 21 was 37.6 and 57.9 years for PWH and uninfected adults, respectively, corresponding with a gap of 20.3 years (95% CI: 18.4-22.1; Figure). Overall life expectancy for PWH increased to 55.5 years in 2014-2016, narrowing the gap to 7.3 years (6.1-8.6). PWH with early ART initiation had a life expectancy at age 21 of 59.4 years in 2014-2016, further narrowing the gap compared with uninfected adults to 3.4 years (0.9-5.8). In 2000-2003, the expected number of comorbidity-free years remaining at age 21 was 11.0 and 26.1 years for PWH and uninfected adults, respectively, with PWH being diagnosed with comorbidities 15.1 years (13.7-16.4) earlier than uninfected adults. This gap persisted in 2014-2016, with comorbidity-free life expectancy at age 21 of 13.3 and 29.3 years for PWH and uninfected adults, respectively (16.1-year gap, 15.1-17.1), and no improvement for PWH with early ART initiation.
Overall lifespan has continued to increase for PWH in care, and only a 3-year gap remains relative to uninfected adults. However, PWH have 16 fewer healthy years than uninfected adults, with diagnoses of common comorbidities beginning at age 34, and no improvement over time or with early ART initiation. Greater attention to comorbidity prevention for PWH is warranted.