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. 2011 Oct 11:343:d6016.
doi: 10.1136/bmj.d6016.

Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study

Margaret May  1 , Mark Gompels, Valerie Delpech, Kholoud Porter, Frank Post, Margaret Johnson, David Dunn, Adrian Palfreeman, Richard Gilson, Brian Gazzard, Teresa Hill, John Walsh, Martin Fisher, Chloe Orkin, Jonathan Ainsworth, Loveleen Bansi, Andrew Phillips, Clifford Leen, Mark Nelson, Jane Anderson, Caroline Sabin
Affiliations

Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study

Margaret May et al. BMJ. .

Abstract

Objectives: To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm(3) at start of antiretroviral therapy.

Design: Cohort study.

Setting: Outpatient HIV clinics throughout the United Kingdom. Population Adult patients from the UK Collaborative HIV Cohort (UK CHIC) Study with CD4 count ≤ 350 cells/mm(3) at start of antiretroviral therapy in 1996-2008.

Main outcome measures: Life expectancy at the exact age of 20 (the average additional years that will be lived by a person after age 20), according to the cross sectional age specific mortality rates during the study period.

Results: 1248 of 17,661 eligible patients died during 91,203 person years' follow-up. Life expectancy (standard error) at exact age 20 increased from 30.0 (1.2) to 45.8 (1.7) years from 1996-9 to 2006-8. Life expectancy was 39.5 (0.45) for male patients and 50.2 (0.45) years for female patients compared with 57.8 and 61.6 years for men and women in the general population (1996-2006). Starting antiretroviral therapy later than guidelines suggest resulted in up to 15 years' loss of life: at age 20, life expectancy was 37.9 (1.3), 41.0 (2.2), and 53.4 (1.2) years in those starting antiretroviral therapy with CD4 count <100, 100-199, and 200-350 cells/mm(3), respectively.

Conclusions: Life expectancy in people treated for HIV infection has increased by over 15 years during 1996-2008, but is still about 13 years less than that of the UK population. The higher life expectancy in women is magnified in those with HIV. Earlier diagnosis and subsequent timely treatment with antiretroviral therapy might increase life expectancy.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Distribution of current CD4 count by period of follow-up
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Fig 2 Life expectancy from age 20-65 of people who started antiretroviral therapy in 2000-8 by CD4 cell count group at start of antiretroviral therapy compared with that of UK population (2000-6 women and men)
See this image and copyright information in PMC

Comment in

  • Life expectancy in HIV.
    Losina E, Freedberg KA. Losina E, et al. BMJ. 2011 Oct 11;343:d6015. doi: 10.1136/bmj.d6015. BMJ. 2011. PMID: 21990259 No abstract available.

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