Life Expectancy Is Steadily Improving for Older People With HIV
Survival after age 50 or older for people with HIV has improved significantly since initiation of combination antiretroviral therapy (cART), a Danish study has found.
“Survival among HIV-infected individuals 50 years or older has increased substantially and is approaching that of the general population. But even among well-treated individuals, survival remains lower than in the general population,” Dr. Rebecca Legarth, of the Department of Infectious Diseases at Copenhagen University Hospital, Rigshospitalet, Denmark, told Reuters Health by email.
Dr. Legarth and colleagues analyzed data from the Danish HIV Cohort Study (DHCS), which includes all HIV-infected individuals treated at Danish HIV centers since 1995, to select 2440 individuals with HIV for the study. They used the Civil Registration System, which is continuously updated, to select a cohort of 14,888 age- and gender-matched individuals as controls.
They estimated cumulative mortality using the Kaplan-Meier estimator and they estimated Mortality Rate Ratios (MRRs) using Cox regression models.
They found that estimated median survival for HIV-infected individuals age 50 and older increased from 11.8 years in 1996-1999 to 22.8 years in 2006-2014.
Estimated median survival for population controls came to 30.2 years for 1996-2014.
MRRs went down from 3.8 for ages 50-55 to 1.6 for ages 75-80, according to an article online August 27 in the Journal of Acquired Immune Deficiency Syndromes.
Excess mortality rates (EMRs) increased with age, from 16.3 for ages 50-55 to 48.8 for ages 75-80, and was highest during the 1996-1999 period.
For 517 well-treated individuals without AIDS-defining events or comorbidity, the MRR came to 1.7 compared with 3192 matched controls without comorbidities. Well-treated individuals had received at least a year of cART, had CD4 cell counts of at least 350/ul, and had HIV RNA less than 500 copies/ml.
Median survival from age 50 for this group came to 25.6 years, compared with 34.2 years for controls.
HIV prevalence in Denmark is 0.1% in adults, and treatment is centralized to eight outpatient centers at 12- to 24-week intervals, with free care provided by the Danish Healthcare system to Denmark residents.
Out of the 2440 patients, 692 were diagnosed with HIV after age 50.
“Individuals in this age group seem to be diagnosed with HIV at a more advanced stage,” Dr. Legarth told Reuters Health. “Furthermore, this group suffers from a higher burden of comorbidity and seems to have a reduced response to treatment. Our research underlines the consequences of such factors, and thereby the importance of addressing these conditions in the clinical approach to older persons at risk of acquiring HIV infection as well as individuals 50 years or older diagnosed with HIV.”
“Future research should focus on identification and qualifying the risk factors associated with the excess mortality observed among older HIV-infected individuals to further reduce mortality,” she said.
Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.