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Narrowing the Gap in Life Expectancy for HIV+ Compared With HIV- Individuals
Julia L. Marcus1; Chun Chao2; Wendy Leyden1; Lanfang Xu2; Charles P. Quesenberry1; Daniel B. Klein3; William J. Towner2; Michael A. Horberg4; Michael J. Silverberg1
1Kaiser Permanente Northern California, Oakland, CA, USA;2Kaiser Permanente Southern California, Pasadena, CA, USA;3Kaiser Permanente San Leandro Med Cntr, San Leandro, CA, USA;4Mid-Atlantic Permanente Med Group, Rockville, MD, USA
Survival of HIV-infected individuals has dramatically improved with combination antiretroviral therapy (ART). However, it is unclear how large a gap in life expectancy remains between HIV-infected and HIV-uninfected individuals, and how much of that gap is attributable to underlying differences in demographics or risk factors.
We conducted a cohort study of HIV-infected adults who were members of Kaiser Permanente California during 1996-2011, and HIV-uninfected members matched 10:1 on age, gender, medical center, and year. Deaths were comprehensively ascertained through 2011 from the electronic health record, California death certificates, and Social Security Administration datasets. We used abridged life tables to estimate the average number of years of life remaining at age 20 (“life expectancy at age 20”) in HIV-infected and HIV-uninfected individuals in 1996-2006 and 2007-2011. For the recent era, we estimated life expectancy at age 20 by demographics and HIV risk group. We also estimated life expectancy in recent years among patients who initiated ART early (i.e., with CD4 ≥500 cells/µL), and in subgroups of these early-treated HIV patients and HIV-uninfected individuals without modifiable risk factors.
Among 25,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2,229 and 4,970 deaths, with mortality rates of 1,827 and 326 per 100,000 person-years, respectively. In 1996-2006, life expectancies at age 20 among HIV-infected and HIV-uninfected individuals were 36.0 and 62.3 years, respectively, corresponding with a gap of 26.3 years (95% confidence interval: 24.8-27.8). In 2007-2011, life expectancy at age 20 for HIV-infected individuals increased to 48.5 years, narrowing the gap to 13.8 years (Table). The lowest life expectancies at age 20 for HIV patients in 2007-2011 were among blacks (45.2 years) and those with a history of injection drug use (42.6 years). In 2007-2011, HIV patients who initiated ART with ≥500 cells/µL had a life expectancy at age 20 of 53.8 years, corresponding with a gap, relative to HIV-uninfected individuals, of 8.5 years. The gap narrowed further to 6-7 years in subgroups without a history of hepatitis B or C infection, drug/alcohol abuse, or smoking.
Even with early ART initiation, an approximately nine-year gap in life expectancy remains between HIV-infected and HIV-uninfected individuals with access to care. Mitigation of risk factors among HIV-infected individuals may further reduce the survival disparity.