Abstract
There is evidence that the life expectancy (LE) of individuals infected with the human immunodeficiency virus (HIV) has increased since the introduction of combination antiretroviral therapy (cART). However, mortality rates in recent years in HIV-positive individuals appear to have remained higher than would be expected based on rates seen in the general population. A low CD4 count, whether due to late HIV diagnosis, late initiation of cART, or incomplete adherence to cART, remains the dominant predictor of LE, and thus the individual’s disease stage at initiation of cART (or thereafter) certainly contributes to these higher mortality rates. However, individuals with HIV also tend to exhibit lifestyles and behaviors that place them at increased risk of mortality, particularly from non-AIDS causes. Thus, although mortality rates among the HIV population may indeed remain slightly higher than those seen in the general population, they may be no higher than those seen in a more appropriately matched control group. Thus, further improvements in LE may now only be possible if some of the other underlying issues (for example, modification of lifestyle or behavioral factors) are tackled.
Highlights
34.3 million people worldwide are thought to be infected with the human immunodeficiency virus (HIV) [1]
The aim of this review is to describe changes in life expectancy (LE) in the HIV-positive population since the introduction of combination antiretroviral therapy (cART), and to consider whether this has reached the same level as in those without HIV infection
The percentage of participants in this study with a standardized mortality ratio (SMR) less than 2 was 46% in men who have sex with men (MSM), 42% in those infected with HIV through heterosexual sex, and 0% among injection drug users; the corresponding percentages of participants with a SMR greater than 10 were 4%, 14%, and 47%,s respectively [24], confirming the negative impact of injection drug use and/or hepatitis co-infection on overall mortality rates [19,21]
Summary
34.3 million people worldwide are thought to be infected with the human immunodeficiency virus (HIV) [1]. The percentage of participants in this study with a SMR less than 2 (that is, individuals whose mortality patterns most closely resembled those in the general population) was 46% in MSM, 42% in those infected with HIV through heterosexual sex, and 0% among injection drug users; the corresponding percentages of participants with a SMR greater than 10 (individuals with the worst mortality patterns) were 4%, 14%, and 47%,s respectively [24], confirming the negative impact of injection drug use and/or hepatitis co-infection on overall mortality rates [19,21] These non-HIV factors may have only a limited influence on deaths from AIDS-related causes, they may play a more major role in deaths from non-AIDS causes, which appear to have increased in frequency in the cART era. In cohorts participating in the ART-CC, incomplete death ascertainment was reported to contribute to the higher mortality rates seen in the North American compared with European cohorts, other patient factors played a role [46]
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