Young people with HIV may now have near-normal life expectancy because of the improvement in treatments, a new study in The Lancet journal suggests. Life expectancy of a 20-year-old who began antiretroviral therapy from 2008 onwards and had a low viral load after a year of treatment may approach that of the general population - around 78 years old, researchers said. These increases are among treated individuals, and are in addition to dramatic life expectancy improvements that occurred after the introduction of antiretroviral therapy in the mid-1990s compared with untreated individuals, they said. The findings could reduce stigmatisation and help people with HIV gain employment and obtain medical insurance, as well as encouraging those diagnosed to start treatment as soon as possible and continue it fully. "Our research illustrates a success story of how improved HIV treatments coupled with screening, prevention and treatment of health problems associated with HIV infection can extend the lifespan of people diagnosed with HIV," said lead author Adam Trickey, from the University of Bristol in the UK. "However, further efforts are needed if life expectancy is to match that of the general population," said Trickey. "Combination antiretroviral therapy has been used to treat HIV for 20 years, but newer drugs have fewer side effects, involve taking fewer pills, better prevent replication of the virus and are more difficult for the virus to become resistant to," he said. The improvements are likely to be a result of the transition to less toxic antiretroviral therapy with more drug options for people infected with a drug-resistant HIV strain and better adherence to treatment, researchers said. This is in addition to improved treatment of co-occurring conditions and opportunistic infections, and increased use of screening and prevention programmes for conditions such as cardiovascular disease and cancer. Antiretroviral therapy first became widely used in 1996.
It involves a combination of three or more drugs that block the HIV virus from replicating, in order to prevent and repair damage to the immune system caused by HIV infection. It also prevents onward spread of the disease. The World Health Organisation (WHO) now recommends antiretroviral therapy to be given as soon as possible after diagnosis to all people with HIV. The study used data for 88,504 people with HIV who started antiretroviral treatment between 1996 and 2010 from 18 European and North American studies. In order to estimate life expectancy, it tracked how many people died during the first three years of their treatment, their cause of death, HIV viral load, immune cell (CD4 cell) count and whether they were infected through injecting drugs. Fewer people who started treatment between 2008-2010 died during their first three years of treatment than those who started treatment between 1996-2007. When looking specifically at deaths due to AIDS, the number of deaths during treatment declined over time between 1996 and 2010, likely as a result of newer drugs being more effective in restoring the immune system. During this time, measures of HIV improved - with the average immune cell count (of CD4 cells in the blood) after a year of treatment increasing from 370 cells per microlitre of blood in 1996-1999, to 430 cells per microlitre in 2008-2010, while the proportion of people with a low HIV viral load increased from 71 per cent to 93 per cent. As a result of these improvements, between 1996 and 2013, the life expectancy of 20-year-olds treated for HIV increased by nine years for women and 10 years for men in the EU and North America. Projections based on death rates in the second and third year of treatment for Europeans and North Americans, estimated that 20-year-olds starting therapy between 2008-2010 who survived the first year of treatment would live to 73 for men and 76 for women. However, the improvements were not seen in all people with HIV, with life expectancy of people who were infected through injecting drugs not increasing as much as in other groups.
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