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Survival in HIV-Infected Patients

Survival among HIV-infected patients has improved in recent years as a result of effective antiretroviral therapy, but it is still not comparable to that of uninfected people.

During the past decade, advances in antiretroviral therapy have led to decreases in morbidity and mortality for people infected with HIV. Population-based studies have reported a 3- to 10-fold improvement in survival with successful HIV treatment, and a computer-generated model suggests that the life expectancy for HIV-infected individuals is now 24.2 years from the time of entering care (ACC Nov 20 2006).

To estimate survival time and age-specific mortality rates for HIV-infected persons compared with the general population in Denmark, investigators used data from the Danish HIV Cohort Study and the Danish Civil Registration System. A total of 3990 HIV-infected individuals were matched for gender, date of birth, and municipality of residence with nearly 380,000 members of the general population. Both groups were 77% men and had a median age of about 37. The median observation time was 5.8 years for HIV-infected individuals and 8.4 years for the general population. Loss to follow-up was 3% for both groups, with most losses due to emigration.

After effective antiretroviral therapy became available in 1996, the proportion of HIV-infected persons receiving treatment increased rapidly, to 75% by 2002. At any given time, fewer than 5% had interrupted therapy. From 2000 through 2005, median life expectancy at age 25 was 33 years for HIV-infected individuals (39 years for those not infected with hepatitis C virus [HCV]) and 51 years for the general population. Mortality rates for HIV-infected persons decreased from 124 per 100 person-years in 1995 and 1996, to 38 per 100 person-years in 1997 through 1999, to 25 per 100 person-years in 2000 through 2005. Among HIV-infected individuals, mortality rates during the study period were considerably higher in those with HCV coinfection than in those without.

Comment: Despite the encouraging gains in survival with the use of potent antiretroviral therapy, marked age-dependent excess mortality is still seen in HIV-infected persons, particularly those who are coinfected with HCV. These results should be interpreted within the context that Denmark provides excellent access to HIV and HCV care; thus, the gains might not be as striking for hard-to-reach populations, such as those that are increasingly affected by HIV and HCV in the U.S. (for example, racial and ethnic minorities and the poor).

— Carlos del Rio, MD

Published in AIDS Clinical Care March 12, 2007

Citation(s):

Lohse N et al. Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 2007 Jan 16; 146:87-95.

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