Introduction of ART has increased life expectancy in HIV patients by 10 years

A study published in the journal The Lancet HIV has found an increase in life expectancy of 20-year-old HIV patients in the EU and North America who had started antiretroviral therapy (ART) after it was introduced mid-1990s. When compared with patients who were not treated with ART, the life expectancy had increased by around a decade in these patients.

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The authors proposed that the study findings might decrease stigmatization and help HIV patients to obtain medical insurance and employment while motivating individuals who are diagnosed to immediately begin and complete treatment.

The study outcomes suggest that a 20-year-old patient might approach the same life expectancy as the general population (approx. 78 years), when they began treatment from 2008 onward and after 1 year of treatment had a low viral load.

Switching to a less toxic ART with more medicine options for patients infected with a drug-resistant HIV strain, better adherence to treatment, enhanced treatment of co-occurring conditions and opportunistic infections and increasing the usage of screening and prevention programs for conditions such as cardiovascular disease and cancer are the possible causes for the development.

In order to prevent and repair damage to the immune system caused by HIV infection, ART involves a combination of three or more drugs that block the HIV virus from replicating. Widely used first in 1996, ART also prevents further spread of the disease. The WHO now proposes ART to be given as soon as possible to all individuals diagnosed with HIV.

The study analyzed data of over 80,000 HIV patients from 18 European and North American countries, who had started antiretroviral treatment between 1996 and 2007. To determine the life expectancy, the study tracked the number of patients that had died during the first 3 years of treatment, death reason, HIV viral load, immune CD4 cell count, and whether they were infected through injecting drugs.

When comparing to patients who started treatment between 1996 and 2007, fewer patients who had started treatment between 2008 and 2010 died during the first three years of the treatment. However, the number of AIDS-related deaths during treatment reduced over time between 1996 and 2010, likely to be because the new drugs were more effective in reestablishing the immune system.

During this time, the HIV measures improved. The average CD4 count increased substantially after 1 year of treatment. The CD4 cell count was increased significantly from 370 cells per microliter of blood in 1996–1999 to 430 cells per microliter in 2008–2010, while the proportion of HIV patients with a low viral load was increased from 71% to 93%.

Consequently, the life expectancy of 20-year-old HIV patients treated with ART increased by 9 years for women and by 10 years for men in the EU and North America during the period 1996 and 2013.

Based on the death rates in the second and third years of treatment for patients in the EU and North America, the projections estimated that 20-year-old male and female HIV patients starting therapy between 2008 and 2010 and, who survived the first year of treatment, would live to 73 and 76 years, respectively.

Yet the improvements were not visible in all HIV patients.  The life expectancy was not increased much in HIV patients who inject drugs, compared with other groups.

The study cited limitations that could have an impact on the results—smaller proportion of infections in people who inject drugs in more recent years, changing patterns of migration from sub-Saharan Africa, the results are applicable only to people who take antiretroviral therapy, while the majority of HIV mortality in the world occurs in people who are not treated with ART. Pooled data is used to estimate the mortality and a few oldest age groups are also in the data and so the mortality rates could not be precisely estimated in these individuals.

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