Life expectancy
Happy new year to all our readers. We hope 2014 will be a happy and healthy year for you. There’s some good news to start the year.
Improvements in treatment and care mean that many people living with HIV now have an excellent life expectancy. However, there are regional variations and research published in 2009 suggested that people with HIV in the United States were still dying 21 years earlier than their HIV-negative peers.
In some cases, life expectancy for people with HIV is now actually longer than the average lifespan of the US population. The findings of the research reinforce the importance of starting HIV treatment before your CD4 cell count falls below 350, as the group of people in the study who did so were amongst the most likely to exceed the average life expectancy – by up to 12 years in some cases. Gay men also saw a large increase in life expectancy.
However, there are still huge variations in life expectancy. People who inject drugs still have a much reduced lifespan compared to the general population. Although there has been a noticeable improvement in prognosis for non-white Americans with HIV, they can still expect to die sooner than their peers without HIV. Disturbingly, only 28% of the study participants had started HIV treatment before their CD4 cell count fell below 350.
Obviously, not all deaths in people with HIV are from HIV-related causes, however. There will be all sorts of factors – including lifestyle and the presence of other health conditions. A second study has looked at the rates and causes of death in people with similar characteristics, some with and some without HIV, to try to assess the impact of HIV on death rates.
Over the years of the study, mortality (death) rates were higher in people with HIV than in those without HIV: 2.3% in people with HIV and 0.37% in HIV-negative people, per year. Of the people with HIV, 11.5% died of AIDS and 6.7% of other conditions during the period of the study
Once again, study results showed that people who started HIV treatment at CD4 cell counts above 350 died at older ages and were more likely to die of non-AIDS-related causes. In fact, they often died at about the same age as people without HIV, and mortality rates for non-HIV-related conditions were not any higher than amongst HIV-negative people.
In comparison, people who started treatment later had higher rates of non-HIV-related illnesses, confirming that HIV treatment reduces the risk of both HIV-related and non-HIV related illnesses.
Other factors such as smoking, depression and high blood pressure increased the chance of death, but the most significant risk factor was co-infection with hepatitis B or C.
People who died of AIDS-related illnesses tended to do so at a younger age; if participants avoided AIDS when younger, they were less likely to die of AIDS-related illnesses in older age. Many of the earlier AIDS-related deaths are likely to be the result of people being on early, less effective treatment.
The researchers say that these studies add further evidence to the benefits of starting HIV treatment in good time, and suggest that large studies looking at prognosis will continue to be important in this next period of HIV treatment.
For more on studies of prognosis and treatment outcomes, read our recent article ‘How much longer have I got?’. It’s part of the final issue of HIV treatment update, available online here: www.aidsmap.com/htu
Treatment during primary HIV infection
The initial phase of infection with HIV is called primary HIV infection. Research into whether taking HIV treatment at this stage has any longer-term health benefits has had mixed results.
Previous research suggested that people with a low CD4 cell count and/or severe symptoms during primary HIV infection could be candidates for early antiretroviral therapy. But there was a call for more research to evaluate the benefits of treatment during primary infection.
Twelve months after stopping treatment, people who took HIV treatment during this period had higher CD4 cell counts and lower viral load than people who hadn’t taken treatment. The benefits of HIV treatment were greatest in people whose CD4 cell count was already quite low and who had higher viral loads at the time they started treatment.
However, the beneficial effects reduced over time and by two years after stopping treatment the differences in CD4 cell count and viral load were no longer significant. Increasing the length of time someone was on HIV treatment did not make a difference.
The SPARTAC trial was set up to investigate whether taking HIV treatment for a short time, soon after infection, would slow down the damage caused by HIV. In 2012, we worked with the SPARTAC trial team in the UK to produce an illustrated leaflet called Very recent infection, which sets out some of the situations where people may consider starting HIV treatment during primary HIV infection. You can find out more about that project in the NAM blog, and view or download the leaflet from www.aidsmap.com/basics
Accuracy of HIV tests
There is a range of HIV testing techniques available and different ones will be used in different circumstances.
Some HIV tests look only for antibodies, molecules produced by the immune system in response to infection and other substances. HIV tests called ‘third-generation’ tests, and most ‘rapid’ HIV tests (ones that give a result while you wait) look for antibodies.
Newer, ‘fourth-generation’ HIV tests (recommended for use in the UK) look for both HIV antibodies and a protein called p24 antigen. Large quantities of this substance are present in blood in the period between HIV infection and the development of antibodies (seroconversion). This period is known as the primary HIV infection period.
Fourth-generation tests can diagnose HIV very soon after infection and the study found them to be very accurate. Rapid HIV tests that looked for both antibodies and p24 – while not as accurate as tests done in a laboratory – were more accurate than antibody-only rapid tests.
The study was reassuring in showing that false positive results are now extremely rare.
You can find more about types of HIV tests and what the results mean on aidsmap.com on the HIV testing topic page.
Editors' picks from other sources
England's HIV services face complex new environment
from The Lancet
HIV prevention and care, and sexual health services, are facing substantial reorganisation in England, with big implications for care.
Rosemary Gillespie to take lead role at Terrence Higgins Trust
from Third Sector
Gillespie, who has also been deputy chief executive at Breast Cancer Care and chief executive of the Roy Castle Lung Cancer Foundation, will take up the post in April. She is currently chief executive of the HIV awareness charity Avert.
Migrants to face NHS emergency care charges
from BBC Health
Overseas visitors and migrants are to face new charges for some NHS services in England, ministers say, but GP consultations will remain free. The government decided that easy initial access to a GP was important to prevent risks to public health such as HIV, TB and sexually transmitted infections.
Openly HIV-positive gay men to paint Soho red on 16 January
from The Gay UK
On Thursday 16th January a bunch of HIV-positive gay men are going to meet up in Soho and go on a pub crawl. In many respects this is entirely ordinary: there are hundreds of gay men living with HIV drinking in the gay bars of Soho every evening. What will be different is that they will be there as openly HIV-positive gay men.