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

Nakagawa, Fumiyoa; Lodwick, Rebecca K.a; Smith, Colette J.a; Smith, Ruthb; Cambiano, Valentinaa; Lundgren, Jens D.c,d; Delpech, Valerieb; Phillips, Andrew N.a

doi: 10.1097/QAD.0b013e32834dcec9
Epidemiology and Social

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.

aHIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London

bHealth Protection Agency, London, UK

cCopenhagen HIV Programme, Panum Institute, University of Copenhagen

dCentre for Viral Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.

Correspondence to Fumiyo Nakagawa, MSc, Research Department of Infection and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK. Tel: +44 20 7794 0500 x34684; e-mail: f.nakagawa@ucl.ac.uk

Received 17 June, 2011

Revised 8 September, 2011

Accepted 4 October, 2011

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© 2012 Lippincott Williams & Wilkins, Inc.