Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care

Abstract

Background: It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care.

Methods: We conducted a cohort study within Kaiser Permanente California during 1996-2011, using abridged life tables to estimate the expected years of life remaining ("life expectancy") at age 20.

Results: Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996-1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9-14.8 years) in 2011. In 2008-2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008-2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1-10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors.

Conclusions: Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.

FIGURE 1

Age-adjusted mortality rates and life expectancy at age 20 for HIV-infected and HIV-uninfected individuals, Kaiser Permanente California, 1996–2011. Rates are represented by solid lines for HIV-infected and dotted lines for HIV-uninfected individuals (P < 0.001 and P = 0.43 for changes over time, respectively). Life expectancies at age 20 are represented by solid circles for HIV-infected and open circles for HIV-uninfected individuals.

FIGURE 2

Life expectancy at age 20 for HIV-infected and HIV-uninfected individuals by demographic characteristics and HIV-transmission risk group, Kaiser Permanente California, 1996–2011. Solid lines represent changes for HIV-infected individuals, with dotted lines for HIV-uninfected individuals. All changes were statistically significant at P < 0.001 for HIV-infected individuals, but only for blacks (P = 0.014) and Hispanics (P = 0.004) for HIV-uninfected individuals.