TY - JOUR

T1 - Projected life expectancy of people with HIV according to timing of diagnosis

AU - Nakagawa, Fumiyo

AU - Lodwick, Rebecca K

AU - Smith, Colette J

AU - Smith, Ruth

AU - Cambiano, Valentina

AU - Lundgren, Jens D

AU - Delpech, Valerie

AU - Phillips, Andrew N

PY - 2012/1/28

Y1 - 2012/1/28

N2 - Background and objectives: Effective antiretroviral therapy (ART) has contributed greatly toward survival for people with HIV, yet many remain undiagnosed until very late. Our aims were to estimate the life expectancy of an HIV-infected MSM living in a developed country with extensive access to ART and healthcare, and to assess the effect of late diagnosis on life expectancy. Methods: A stochastic computer simulation model of HIV infection and the effect of ART was used to estimate life expectancy and determine the distribution of potential lifetime outcomes of an MSM, aged 30 years, who becomes HIV positive in 2010. The effect of altering the diagnosis rate was investigated. Results: Assuming a high rate of HIV diagnosis (median CD4 cell count at diagnosis, 432¿cells/µl), projected median age at death (life expectancy) was 75.0 years. This implies 7.0 years of life were lost on average due to HIV. Cumulative risks of death by 5 and 10 years after infection were 2.3 and 5.2%, respectively. The 95% uncertainty bound for life expectancy was (68.0,77.3) years. When a low diagnosis rate was assumed (diagnosis only when symptomatic, median CD4 cell count 140¿cells/µl), life expectancy was 71.5 years, implying an average 10.5 years of life lost due to HIV. Conclusion: If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals. The greatest risk of excess mortality is due to delays in HIV diagnosis

AB - Background and objectives: Effective antiretroviral therapy (ART) has contributed greatly toward survival for people with HIV, yet many remain undiagnosed until very late. Our aims were to estimate the life expectancy of an HIV-infected MSM living in a developed country with extensive access to ART and healthcare, and to assess the effect of late diagnosis on life expectancy. Methods: A stochastic computer simulation model of HIV infection and the effect of ART was used to estimate life expectancy and determine the distribution of potential lifetime outcomes of an MSM, aged 30 years, who becomes HIV positive in 2010. The effect of altering the diagnosis rate was investigated. Results: Assuming a high rate of HIV diagnosis (median CD4 cell count at diagnosis, 432¿cells/µl), projected median age at death (life expectancy) was 75.0 years. This implies 7.0 years of life were lost on average due to HIV. Cumulative risks of death by 5 and 10 years after infection were 2.3 and 5.2%, respectively. The 95% uncertainty bound for life expectancy was (68.0,77.3) years. When a low diagnosis rate was assumed (diagnosis only when symptomatic, median CD4 cell count 140¿cells/µl), life expectancy was 71.5 years, implying an average 10.5 years of life lost due to HIV. Conclusion: If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals. The greatest risk of excess mortality is due to delays in HIV diagnosis

U2 - 10.1097/QAD.0b013e32834dcec9

DO - 10.1097/QAD.0b013e32834dcec9

M3 - Journal article

C2 - 22089374

VL - 26

SP - 335

EP - 343

JO - AIDS

JF - AIDS

SN - 1350-2840

IS - 3

ER -