Background
Life expectancy for people with HIV (PWH) has increased dramatically, but disparities may remain across sub-populations. We aimed to characterize life expectancy over 2 decades by sex and race/ethnicity for virally suppressed PWH in the Bronx, New York – a low income area with a largely Black and Hispanic population and high proportion of women with HIV.
Methods
PWH receiving care in the Montefiore Health System in the Bronx with at least 2 viral load measurements obtained at least 30 days apart were included. Viral suppression was defined retrospectively as the earliest date (1997-2021) in a one-year window where at least 80% of all viral load measurements were suppressed (<1000 copies/mL). Follow-up ended at death (via National Death Index), loss to follow-up, or the end of the analysis window (end of 2022). A Poisson regression model with offset for years of follow-up was used to estimate mortality rate ratios and 95% confidence intervals according to time period and age at earliest viral suppression, sex at birth, and race/ethnicity. Based on the Poisson model, expected remaining years of life were estimated for a 30-year-old via Chiang’s method with bootstrapped 95% confidence intervals.
Results
PWH (n=10,308; 42% women, 43% non-Hispanic Black, 40% Hispanic, 5% non-Hispanic White) were followed for an average of 10 years (interquartile range 4-15), during which 2,813 (27%) died. As expected, risk of mortality declined over time, corresponding to a ~10 year increase in life expectancy since the late 1990s. Women had 28% (22-34) lower mortality risk than men. Compared to Black PWH, Hispanic PWH had 20% (12-28) lower mortality risk, while White PWH or those with other/unknown race/ethnicity had higher mortality risk (White: 18% [-1,40]; other/unknown: 51% [32,72]). Adjustment for CD4+ T-cell count and health insurance did not materially alter these results. Hispanic women had the highest estimated life expectancy, and men of other/unknown race/ethnicity had the lowest (50 and 35 years for 30-year-old with earliest viral suppression within 2017-2021, respectively) (Figure).
Conclusions
Virally suppressed women and Hispanic PWH in the Bronx have longer lifespans than comparable men and other race/ethnic groups, respectively, consistent with sex and race/ethnic disparities in lifespan in the U.S. among people without HIV. Yet, lifespan for non-Hispanic PWH in the Bronx remains lower than the general U.S. population.
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