Key messages
In countries with well-structured and well-funded health systems, the life expectancy of people living with HIV has almost converged with that of the general population. However, differences in lifetime in good health remain: already in the early 50s People with HIV have twice as many comorbidities as non-infected people and these differences persist in the following years (Lancet HIV https://doi.org/10.1016/S2352-3018(22)00400-3).With a higher disease burden correlate specifically lower CD4 cell counts (<200/μl) and Therapeutic phases with the intake of nucleoside reverse transcriptase inhibitors (NRTI).
Background
The life expectancy of people with HIV and AIDS generally depends on immune status and timely, effective HIV treatment with few side effects. For example, if HIV therapy began at the turn of the millennium, HIV-infected people can expect an almost normal life expectancy (1). For some time, however, differences in comorbidities compared to the general population have been observed, but the control groups have never been comparable to those of HIV-infected people in terms of lifestyle aspects. This gap is closed for the first time by a large prospective longitudinal study from the Netherlands (2).
Design
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Type of study: prospective, longitudinal cohort study with participants from the greater Amsterdam area
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Recruitment criteria: Age from 45 years (average: 52 years at enrollment),
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Information about HIV status, medical treatment, Lifestyle such as smoking, frequency and intensity of alcohol or drug use, body mass index, body weight and comorbidities
Type of study: prospective, longitudinal cohort study with participants from the greater Amsterdam area
Recruitment criteria: Age from 45 years (average: 52 years at enrollment),
Information about HIV status, medical treatment, Lifestyle such as smoking, frequency and intensity of alcohol or drug use, body mass index, body weight and comorbidities
Main results
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596 HIV-positive individuals were included and 550 HIV-negative.
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The two cohorts were comparable in terms of demographic characteristics and all other inclusion criteria.78.5% were men who reported having sex with men (MSM). The remainder did not provide any information or were not MSMs (16.5%).
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At baseline, 55.5% in the cohort with HIV infection and 74.2% in the cohort without HIV infection were without comorbidities. The rest had 1 comorbidity (29.4% vs. 21.5%; HIV-positive vs. HIV-negative participants), 2 comorbidities (10.9% vs. 3.1%) or at least 3 comorbidities (4.2% vs. 1.3%).
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The total of 1,146 participants were followed for a median of 5.9 years (5.7-6.0 years).
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During this period, 5.2% died in the HIV-positive group – none from AIDS – and 1.3% in the HIV-negative group. The differences are mainly due to more gastrointestinal tumors, lung carcinomas and hematological malignancies, as well as more frequent multiple organ failure and more cardiovascular diseases in HIV positivity.
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The average comorbidity rate increased at a comparable rate over time in both groups.It was 1.04 annually in the cohort with HIV infection and 1.05 in the cohort without HIV infection.
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In addition, the burden of disease between the two groups was compared as disability-adjusted life years (DALYs). DALY is made up of the years of life lost due to death and health restrictions.
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Here there were clear and significant differences in the course. The average increase in DALYs was 0.209 per year for HIV-positive participants vs. 0.091/year for HIV-negative participants, a difference by a factor of 2.3 (p=0.0045).
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Within the HIV-positive group of participants, the increase in DALYs was faster when NRTIs had been taken in the past, and also stronger with CD4 cell counts <200/μl.
596 HIV-positive individuals were included and 550 HIV-negative.
The two cohorts were comparable in terms of demographic characteristics and all other inclusion criteria.78.5% were men who reported having sex with men (MSM). The remainder did not provide any information or were not MSMs (16.5%).
At baseline, 55.5% in the cohort with HIV infection and 74.2% in the cohort without HIV infection were without comorbidities. The rest had 1 comorbidity (29.4% vs. 21.5%; HIV-positive vs. HIV-negative participants), 2 comorbidities (10.9% vs. 3.1%) or at least 3 comorbidities (4.2% vs. 1.3%).
The total of 1,146 participants were followed for a median of 5.9 years (5.7-6.0 years).
During this period, 5.2% died in the HIV-positive group – none from AIDS – and 1.3% in the HIV-negative group. The differences are mainly due to more gastrointestinal tumors, lung carcinomas and hematological malignancies, as well as more frequent multiple organ failure and more cardiovascular diseases in HIV positivity.
The average comorbidity rate increased at a comparable rate over time in both groups.It was 1.04 annually in the cohort with HIV infection and 1.05 in the cohort without HIV infection.
In addition, the burden of disease between the two groups was compared as disability-adjusted life years (DALYs). DALY is made up of the years of life lost due to death and health restrictions.
Here there were clear and significant differences in the course. The average increase in DALYs was 0.209 per year for HIV-positive participants vs. 0.091/year for HIV-negative participants, a difference by a factor of 2.3 (p=0.0045).
Within the HIV-positive group of participants, the increase in DALYs was faster when NRTIs had been taken in the past, and also stronger with CD4 cell counts <200/μl.
Clinical significance
The difference in predicted life expectancy between HIV-infected and uninfected individuals has decreased significantly in recent years.However, there remains a difference in the years of life lost due to health restrictions and premature death.
According to the authors and commentators, these results indicate that even in Western countries with well-functioning health systems, monitoring and possibly also the thresholds for starting therapies need to be better adapted to people with HIV (3). The number of People with HIV in Germany are estimated at 85,300–96,000 (4).
Funding: public funds
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Source — https://www.univadis.de/viewarticle/menschen-mit-hiv-leben-weniger-jahre-bei-guter-gesundheit-2023a10006a1