Combo Therapy Boosts HIV Life Expectancy

Study Shows HIV Patients Are Living Longer Since Start of Antiretroviral Drug Therapy

By Jennifer Warner
WebMD Health News

Reviewed By Brunilda Nazario, MD

July 24, 2008 — A 20-year-old diagnosed with HIV can now expect to live 13 years longer than the same person diagnosed with the virus that causes AIDS in 1996, according to a new study on HIV life expectancy.

Researchers credit the dramatic rise in life expectancy for people with HIV to advances in the "gold standard" for HIV treatment: combination antiretroviral drug therapy. The therapy utilizes a cocktail of various drugs that targets the virus in different ways to lower the level of HIV circulating in the body. The mix of drugs in the cocktail is modified as the virus becomes resistant or side effects of the HIV treatment become problematic.

The study shows that since the introduction of combination antiretroviral drug therapy for HIV in 1996, the average life expectancy has increased from 36.1 years in 1996-1999 to 49.4 years in 2003-2005. In addition, death rates for people with HIV who received combination antiretroviral drug therapy dropped by about 40% during the same period.

"These advances have transformed HIV from being a fatal disease, which was the reality for patients before the advent of combination treatment, into a long-term chronic condition," write researcher Robert Hogg, of the British Columbia Centre for Excellence in HIV/AIDS, in Vancouver, Canada and colleagues in The Lancet.

Combination Therapy and HIV Life Expectancy

Although previous studies have shown that combination antiretroviral drug therapy has led to significant increases in survival and quality of life for people with HIV, researchers say the impact on life expectancy on a population-wide level has not been examined until now.

In the study, researchers followed three groups of HIV-positive people in Europe and North America who began antiretroviral drug therapy in 1996-1999, 2000-2002, and 2003-2005, respectively. There were 18,587 patients in the first group, 13,914 patients in the second group, and 10,854 in the third group.

Overall, 4.7% of the participants died during the course of the study. The average mortality rate decreased from 16.3 deaths per 1,000 person-years in 1996-1999 to 10 deaths per 1,000 person-years in 2003-2005, a drop of about 40%.

Researchers found the average life expectancy for a 20-year-old diagnosed with HIV increased by more than 13 years during the study.

In addition, the study showed several factors were associated with HIV life expectancy, including:

  • Those treated later in the course of their infection had lower life expectancy than those treated early on.
  • Participants with lower infection-fighting white blood cell counts tended to have a lower life expectancy than others (32.4 years compared with 50.4 years).
  • Those who became infected with HIV through injected drug use had a shorter life expectancy (32.6 years) than those who became infected with HIV in other ways (44.7 years)
  • Women had a slightly longer life expectancy than men (44.2 vs. 42.8 years), which researchers say is probably due to the fact that women, on average, started their HIV treatment earlier in the course of HIV infection than men.

In a commentary that accompanies the study, David A. Cooper of the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales in Sydney, Australia, says that with the advent of combination antiretroviral therapy the outlook for people with HIV has become less bleak and diagnosis has moved away from being an immediate death sentence.

"During the past 10 years, the discourse with patients has changed. They want to know how long they have to live. They want to plan their lives better. Should they consider life insurance, health insurance, or superannuation for retirement?"

Despite these positive results, researchers say more work is needed to close a nearly two-decade gap in life expectancy: An HIV-positive person who started on combination antiretroviral drug therapy at age 20 can expect to live to age 63 compared with an HIV-negative person in a wealthy country, who can expect to live around 80 years.

SOURCES: Hogg, R. The Lancet, July 26, 2008; vol 372: 273-299. News release, The Lancet.

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