Life expectancy in HIV-positive persons in Switzerland: matched comparison with general population

Abstract

Objectives: To estimate life expectancy over 25 years in HIV-positive people and to compare their life expectancy with recent estimates for the general population, by education.

Methods: Patients aged 20 years or older enrolled in the Swiss HIV Cohort Study 1988-2013 were eligible. Patients alive in 2001 were matched to up to 100 Swiss residents, by sex, year of birth, and education. Life expectancy at age 20 was estimated for monotherapy (1988-1991), dual therapy (1992-1995), early combination antiretroviral therapy (cART, 1996-1998), later cART (1999-2005) and recent cART (2006-2013) eras. Parametric survival regression was used to model life expectancy.

Results: In all, 16 532 HIV-positive patients and 927 583 residents were included. Life expectancy at age 20 of HIV-positive individuals increased from 11.8 years [95% confidence interval (CI) 11.2-12.5] in the monotherapy era to 54.9 years (95% CI 51.2-59.6) in the most recent cART era. Differences in life expectancy across educational levels emerged with cART. In the most recent cART period, life expectancy at age 20 years was 52.7 years (95% CI 46.4-60.1) with compulsory education, compared to 60.0 years (95% CI 53.4-67.8) with higher education. Estimates for the general population were 61.5 and 65.6 years, respectively. Male sex, smoking, injection drug use, and low CD4 cell counts at enrolment were also independently associated with mortality.

Conclusion: In Switzerland, educational inequalities in life expectancy were larger among HIV-infected persons than in the general population. Highly educated HIV-positive people have an estimated life expectancy similar to Swiss residents with compulsory education. Earlier start of cART and effective smoking-cessation programs could improve HIV-positive life expectancy further and reduce inequalities.

Fig. 1

Introduction of monotherapy, dual therapy, and triple combination antiretroviral therapy (cART) in the Swiss HIV cohort (1988–2013).

Fig. 2

Life expectancy at age 20 years in patients enrolled in the Swiss HIV Cohort Study, from monotherapy (1988–1991) to recent combination ART era (2006–2013), and in a matched sample from the general Swiss population (2001–2013).

Fig. 3

Life expectancy at age 20 years by education in patients enrolled in the Swiss HIV Cohort Study, from dual therapy (1992–1995) to recent combination ART era (2006–2013), and in a matched sample from the general Swiss population (2001–2013).