Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada.

Sophie Patterson,Ann N Burchell,Nima Machouf,Julio S G Montaner,Curtis Cooper,Hasina Samji,Marina B Klein,Robert S Hogg,Wendy Zhang,Janet Raboud,Chris Tsoukas,Mona R Loutfy,Keith Chan,Angela Cescon,Sean B Rourke

doi:10.1186/s12879-015-0969-x

Abstract

BackgroundWe sought to evaluate life expectancy and mortality of HIV-positive individuals initiating combination antiretroviral therapy (ART) across Canada, and to consider the potential error introduced by participant loss to follow-up (LTFU).MethodsOur study used data from the Canadian Observational Cohort (CANOC) collaboration, including HIV-positive individuals aged ≥18 years who initiated ART on or after January 1, 2000. The CANOC collaboration collates data from eight sites in British Columbia, Ontario, and Quebec. We computed abridged life-tables and remaining life expectancies at age 20 and compared outcomes by calendar period and patient characteristics at treatment initiation. To correct for potential underreporting of mortality due to participant LTFU, we conservatively estimated 30 % mortality among participants lost to follow-up.Results9997 individuals contributed 49,589 person-years and 830 deaths for a crude mortality rate of 16.7 [standard error (SE) 0.6] per 1000 person-years. When assigning death to 30 % of participants lost to follow-up, we estimated 1170 deaths and a mortality rate of 23.6 [SE 0.7] per 1000 person-years. The crude overall life expectancy at age 20 was 45.2 [SE 0.7] and 37.5 [SE 0.6] years after adjusting for LTFU. In the LTFU-adjusted analysis, lower life expectancy at age 20 was observed for women compared to men (32.4 [SE 1.1] vs. 39.2 [SE 0.7] years), for participants with injection drug use (IDU) history compared to those without IDU history (23.9 [SE 1.0] vs. 52.3 [SE 0.8] years), for participants reporting Aboriginal ancestry compared to those with no Aboriginal ancestry (17.7 [SE 1.5] vs. 51.2 [SE 1.0] years), and for participants with CD4 count <350 cells/μL compared to CD4 count ≥350 cells/μL at treatment initiation (36.3 [SE 0.7] vs. 43.5 [SE 1.3] years). Life expectancy at age 20 in the calendar period 2000–2003 was lower than in periods 2004–2007 and 2008–2012 in the LTFU-adjusted analyses (30.8 [SE 0.9] vs. 38.6 [SE 1.0] and 54.2 [SE 1.4]).ConclusionsLife expectancy and mortality for HIV-positive individuals receiving ART differ by calendar period and patient characteristics at treatment initiation. Failure to consider LTFU may result in underestimation of mortality rates and overestimation of life expectancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0969-x) contains supplementary material, which is available to authorized users.

Highlights

We sought to evaluate life expectancy and mortality of HIV-positive individuals initiating combination antiretroviral therapy (ART) across Canada, and to consider the potential error introduced by participant loss to follow-up (LTFU)
Data source The Canadian Observational Cohort (CANOC) collaboration is a pan-provincial cohort of HIV-positive individuals initiating ART naively, established to evaluate patterns of treatment uptake and response, and health service provision and outcomes across Canada
We considered differences in mortality rates and life expectancy in subgroups defined by patient characteristics at initiation of treatment

Summary

Introduction

We sought to evaluate life expectancy and mortality of HIV-positive individuals initiating combination antiretroviral therapy (ART) across Canada, and to consider the potential error introduced by participant loss to follow-up (LTFU). With improvements in treatment regimen access, uptake and efficacy, the mortality and morbidity of HIV-positive persons have significantly decreased over time [8, 9]. Other non-AIDS defining comorbidities are of increasing concern for HIV-positive individuals accessing ART; including malignancy, cardiovascular disease, pulmonary disease, liver disease, and renal disease [10, 11]. These comorbidities are hypothesized to occur at a higher rate among people living with HIV due to immunodeficiency [10], inflammation [12], a higher prevalence of behavioural risk factors [10], viral coinfections and the toxicity of antiretroviral regimens [13]

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Results

Conclusion