HIV-positive 20-year-olds who began antiretroviral therapy in 2010 are now expected to live a decade longer than similarly-aged patients who started treatment less than 15 years ago, a team of researchers from the University of Bristol reported this week in the journal The Lancet.
The authors, who are members of the university’s Antiretroviral Therapy Cohort Collaboration, also found that the life expectancy of a 20-year-old who began treatment in 2008 and had a low viral load after one full year of treatment may have a life expectancy similar to that of a healthy person (approximately 78 years old).
The transition to less toxic antiretroviral therapy, an increase in the number of treatment options and better adherence to doctor’s instructions are among the factors being credited for the trends, the researchers explained in a statement. However, those HIV patients are the exception, not the rule, they added: most continue to have a lower life expectancy than the general population.
“Our research illustrates a success story of how improved HIV treatments coupled with screening, prevention and treatment of health problems associated with HIV infection can extend the lifespan of people diagnosed with HIV,” said lead author Adam Trickey from the university’s School of Social and Community Medicine.
“Combination antiretroviral therapy has been used to treat HIV for 20 years, but newer drugs have fewer side effects, involve taking fewer pills, better prevent replication of the virus and are more difficult for the virus to become resistant to… Since modern treatment is highly effective with low toxicity,” he added, “now we need to focus on the issues surrounding drug adherence, late diagnosis of HIV, and diagnosis and treatment of co-occurring conditions.”
Antiretroviral treatment success ‘a tremendous medical achievement’
The study authors reviewed data from more than 88,500 HIV-positive patients from 18 different countries in Europe and North America, all of whom had started antiretroviral treatment between 1996 and 2010. They tracked the number of people who died during the first three years of their treatment, along with their cause of death, HIV viral load and immune cell count.
They found that fewer people who started treatment after 2008 died during their first three years of treatment compared to those who began therapy between 1996 and 2007. Furthermore, people who died specifically of AIDS during their treatment also declined between 1996 and 2010. This is likely due to the improved ability of newer drugs to restore the immune system, they said.
Improvements were observed in other areas as well. The average immune cell count (CD4 cells in the blood) following one year of treatment increased from 370 cells per microliter of blood in 1996-1999 to 430 cells per microliter in 2008-2010, and the percentage of patients who had low HIV viral loads increased from 71 percent to 93 percent over that time period.
Due to these advances, the life expectancy of 20-year-olds treated for HIV increased by 10 years for men and nine years for women in Europe and North America from 1996 and 2013, Trickey’s team reported in their study. Based on their projections, 20-year-old males who started treatment after 2008 and survived their first year of therapy are expected to live until the age of around 73, while females are expected to live to about 76.
“It’s a tremendous medical achievement that an infection that once had such a terrible prognosis is now so manageable, and that patients with HIV are living significantly longer,” Helen Stokes-Lampard, chairperson of the Royal College of General Practitioners, told BBC News. “We hope the results of this study go a long way to finally removing any remaining stigma associated with HIV.”
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