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Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy

May, Margaret T.a; Gompels, Markb; Delpech, Valeriec; Porter, Kholoudd; Orkin, Chloee; Kegg, Stephenf; Hay, Phillipg; Johnson, Margareth; Palfreeman, Adriani; Gilson, Richardj; Chadwick, Davidk; Martin, Fabiolal; Hill, Teresam; Walsh, Johnn; Post, Franko; Fisher, Martinp; Ainsworth, Jonathanq; Jose, Sophiem; Leen, Cliffordr; Nelson, Marks; Anderson, Janet; Sabin, Carolinem; for the UK Collaborative HIV Cohort (UK CHIC) Study

doi: 10.1097/QAD.0000000000000243
Epidemiology and Social

Objective: The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART).

Methods: Patients aged more than 20 years who started ART during 2000–2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012. We determined the latest CD4+ cell count and viral load before ART and in each of years 1–5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4+ cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20–85 years.

Results: Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 person-years. At start of ART, expected age at death [95% confidence interval (CI)] of 35-year-old men with CD4+ cell count less than 200, 200–349, at least 350 cells/μl was 71 (68–73), 78 (74–82) and 77 (72–81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five-year-old men who increased their CD4+ cell count in the first year of ART from less than 200 to 200–349 or at least 350 cells/μl and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48–61) (CD4+ cell count <200 cells/μl and no viral suppression) to 80 (76–83) years (CD4+ cell count ≥350 cells/μl and viral suppression).

Conclusion: Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4+ cell count significantly improve their life expectancy if they have a good CD4+ cell count response and undetectable viral load.

aUniversity of Bristol

bNorth Bristol NHS Trust, Bristol

cPublic Health England

dMedical Research Council Clinical Trials Unit

eBarts and The London NHS Trust

fSouth London Healthcare NHS Trust

gSt George's Healthcare NHS Trust

hRoyal Free Hampstead NHS Trust, London

iUniversity Hospitals of Leicester NHS Trust, Leicester

jMortimer Market Centre, University College Medical School, London

kSouth Tees Hospital NHS Foundation Trust, Middlesbrough

lYork Teaching Hospital NHS Foundation Trust, York

mResearch Department of Infection & Population Health, UCL

nImperial College Healthcare NHS Foundation Trust

oKings College Healthcare NHS Foundation Trust and Kings College London, London

pBrighton and Sussex University Hospitals NHS Trust, Brighton

qNorth Middlesex University Hospital NHS Trust, London

rThe Lothian University Hospitals NHS Trust, Edinburgh

sChelsea and Westminster NHS Foundation Trust

tHomerton University Hospital NHS Trust, London, UK.

Correspondence to Dr Margaret T. May, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK. Tel: +44 117 9287287; fax: +44 117 928 7325; e-mail: m.t.may@bristol.ac.uk

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Received October 24, 2013

Accepted January 31, 2014

© 2014 Lippincott Williams & Wilkins, Inc.