番茄社区

Early initiation of antiretroviral therapy (ART) in HIV patients appeared to normalize life spans when they had high CD4 cell counts, researchers found.

Less than three years' difference was seen between HIV-infected adults with successful early ART and uninfected controls, based on 2014-2016 data, reported Julia Marcus, PhD, of Harvard Medical School in Boston.

However, a 16-year gap remained in comorbidity-free years, she reported at the virtual Conference on Retroviruses and Opportunistic Infections (CROI).

Marcus noted that ART has dramatically increased life expectancy for people living with HIV, with improved treatment meaning that life expectancy gaps are continuing to narrow between people living with and without HIV.

Her group set out to quantify how much the gap had narrowed and how many of those life years were healthy, or comorbidity-free, for these populations. They examined data from Kaiser Permanente in northern California, southern California, and the mid-Atlantic states, from 2000-2016, with frequency matching in a 1:10 ratio for infected individuals and uninfected controls on age, sex, race/ethnicity, medical center, and year.

In addition, they examined data on specific comorbidities, such as chronic liver, kidney, and lung disease, as well as diabetes, cancer, and cardiovascular disease, and created "abridged life tables" to estimate the number of overall and comorbidity-free years remaining for these populations at age 21.

The cohort comprised 39,000 people living with HIV, and about 390,000 controls. Mean age was 41, nearly all were men, 45% were white, 25% were black, and 24% were Latinx. Among the group with HIV, 70% were men who have sex with men (MSM), about two-thirds initiated ART during follow-up, and around 30% had a CD4 count of at least 500 at ART initiation.

Overall, researchers found a narrowing gap in overall life expectancy, as people without HIV had a life expectancy of 65 years at age 21, or living to age 86 based on 2014-2016 data. A person living with HIV had a life expectancy of 56 years, or living to age 77 during the same time period, for a gap of nine years.

However, the same could not be said for comorbidity-free years between the two groups. People without HIV could be expected to have 31 comorbidity-free years, or to live to age 52 without being diagnosed with a major chronic comorbidity, while people with HIV could be expected to live to age 36 until the same diagnosis.

Marcus noted that examining each comorbidity separately, there was a persistent gap in comorbidity-free life expectancy for liver, kidney, and lung disease between the two groups, with a narrowing gap in comorbidity-free life expectancy for diabetes, cancer, and cardiovascular disease.

But the gap in overall life expectancy almost vanished when the analysis was restricted to people living with HIV who initiated ART early and had high CD4 counts, though that wasn't the case for remaining free of comorbidities. This group averaged 13 comorbidity-free years from age 21, versus 29 years for controls.

Marcus said that comorbidity-free life expectancy did improve in the early-ART group for cancer and cardiovascular disease -- but not for diabetes, kidney, lung, or liver disease.

"The gap in healthier years has narrowed for some, but not all comorbidities," Marcus said. "Greater attention is needed for comorbidity prevention for people with HIV."