7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

Abstract

TUPE260 - Poster Exhibition


Increases in life expectancy among treated HIV-positive individuals in the United States and Canada, 2000-2007

R.S. Hogg1,2, K.N. Althoff3, H. Samji1, A. Cescon1, S. Modur3, K. Buchacz4, A.N. Burchell5, M. Cohen6, K.A. Gebo3, M.J. Gill7, A. Justice8, G. Kirk3, M.B. Klein9, P.T. Korthuis10, J. Martin11, S. Napravnik12, S.B. Rourke5, T.R. Sterling13, M.J. Silverberg14, S. Deeks15, L.P. Jacobson3, R.J. Bosch16, M.M. Kitahata17, J.J. Goedert18, R. Moore3, S.J. Gange3, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA

1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2Simon Fraser University, Burnaby, Canada, 3Johns Hopkins University, Baltimore, United States, 4Centers for Disease Control and Prevention, Atlanta, United States, 5Ontario HIV Treatment Network, Toronto, Canada, 6The Core Center, Bureau of Health Services of Cook County, Chicago, United States, 7University of Calgary, Calgary, Canada, 8Veterans Administration Connecticut Healthcare System and Yale University, West Haven, United States, 9McGill University, Montreal, Canada, 10Oregon Health and Science University, Portland, United States, 11University of California, San Francisco, United States, 12University of North Carolina at Chapel Hill, Chapel Hill, United States, 13Vanderbilt University, Nashville, United States, 14Kaiser Permanente, Oakland, United States, 15San Francisco General Hospital, San Francisco, United States, 16Harvard School of Public Health, Boston, United States, 17University of Washington, Seattle, United States, 18National Cancer Institute, Rockville, United States

Background: Combination antiretroviral therapy (ART) has significantly increased survival among HIV-positive adults in the United States (U.S.) and Canada, but gains in life expectancy for this region have not been characterized. We aim to estimate temporal changes in life expectancy among HIV-positive adults on ART from 2000-2007 in the U.S. and Canada.
Methods: Participants were from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), aged ≥20 years and treatment-naive before initiating ART. Mortality rates were calculated using participants' person-time from 1 January 2000 or ART initiation until death, loss to follow-up, or administrative censoring at 31 December 2007. Life expectancy at age 20, defined as the average number of additional years that a person of a specific age will live, provided the current age-specific mortality rates remain constant, was estimated using abridged life tables.
Results: The crude mortality rate was 19.8 per 1,000 person-years, among 22,937 individuals (23% female; 62% non-white) contributing 82,022 person-years and 1,622 deaths. Life expectancy at age 20 increased from 36.1 [standard error (SE) 0.5] to 51.4 [SE 0.3] years from 2000-02 to 2006-07. Men and women had comparable life expectancies in all periods except the last (2006-07), in which men expected to live 6.1 more years. Life expectancy was lower for individuals with a history of injection drug use, non-whites, and in patients with baseline CD4 counts < 350 cells/mm3.
Conclusion: A 20-year-old HIV-positive individual on ART in the U.S. or Canada is expected to live into their early 70s, a life expectancy approaching that of the general population. Differences by sex, race, HIV transmission risk group, and CD4 count remain.

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