The
expected survival time of HIV positive individuals
in all age groups is a major public health concern, and of course is of even greater
concern to people living with HIV. However,
there are scant data on this issue worldwide.
Denmark
carefully tracks each of its residents' vital status, which has made it possible
for researchers to accurately compare survival of HIV
positive and HIV negative individuals in that country.
As
described in the January 11, 2007 Annals of Internal Medicine, Danish researchers
undertook a population-based cohort study of all HIV positive persons receiving
care in Denmark from 1995 through 2005 to estimate survival times and age-specific
mortality rates of the HIV positive population compared with that of the general
population.
Each
member of the nationwide Danish HIV Cohort Study was matched with as many as 99
individuals from the general population according to sex, date of birth, and municipality
of residence.
The
authors computed Kaplan-Meier life tables with age as the time scale to estimate
survival from the age of 25 years. Patients with HIV infection and corresponding
subjects from the general population were observed from the date of the patients’
HIV diagnosis until death, emigration, or May 1, 2005.
Results
3990
HIV positive patients and 379,872 matched subjects from the general population
were included in the analysis, yielding 22,744 and 2,689,287 person-years of observation,
respectively.
3%
of study participants were lost to follow-up.
From
the age of 25 years, the median survival was 19.9 years for HIV positive patients
and 51.1 years for individuals in the general population.
For
HIV-infected individuals, survival increased to 32.5 years during the period 2000-2005
(the early HAART era).
In
a subgroup that excluded the 16% of HIV positive individuals with known hepatitis
C virus (HCV) coinfection, median survival was 38.9 years during this same period.
Observed
mortality rates were 43 per 1000 person-years
for HIV positive patients compared with 4.7 per 1000 person-years for individuals
in the general population.
However,
among people with HIV, mortality fell significantly following the introduction
of HAART, from 124 per 1000 person-years in the
1995-1996 period to 25 per 1000 person-years after 2000.
The
relative mortality rates for people with HIV compared with those for the general
population decreased with increasing age, whereas the excess mortality rate increased
with increasing age.
The
proportion of deaths directly attributable to HIV fell from 76% in the 1995-1996
period to 43% in 2000-2005.
Based
on these findings, the authors concluded, “The estimated median survival is more than 35 years for a young
person diagnosed with HIV infection in the late highly active antiretroviral therapy
[HAART] era. However, an ongoing effort is still needed to further reduce mortality
rates for these persons compared with the general population.”
Discussion
The
conclusions of this study suggest that HIV positive individuals have a reasonably
good -- but far from normal -- life expectancy. It should also be noted that Denmark
provides excellent access to HIV and HCV care, so the resultsmay be
atypically positive compared to most other countries.
“Patients
with HIV can have a life expectancy comparable to diabetics,” stated lead investigator
Nicolai Lohse,MD. "As a result, they will need to ensure they plan properly
for the future.”
“The
longer life expectancy calls for physicians to pay attention to prevention and
treatment of other lifestyle-related diseases,” he added.
Odense
University Hospital and University of Southern Denmark, Odense, Denmark; Århus
University Hospital and Århus University, Århus, Denmark; Hvidovre University
Hospital, Hvidovre, Denmark; Rigshospitalet, Copenhagen, Denmark; Boston University,
Boston, Massachusetts.
01/26/07
Reference N
Lohse, A-B Hansen, G Pedersen, and others. Survival of Persons with and without
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The
expected 
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