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Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6016 (Published 11 October 2011) Cite this as: BMJ 2011;343:d6016
  1. Margaret May, senior research fellow1,
  2. Mark Gompels, consultant physician, director2,
  3. Valerie Delpech, consultant epidemiologist, head of HIV and AIDS reporting section3,
  4. Kholoud Porter, senior epidemiologist4, honorary reader5,
  5. Frank Post, clinical senior lecturer in HIV medicine6,
  6. Margaret Johnson, professor and consultant physician of general medicine, HIV/AIDS, and thoracic medicine7,
  7. David Dunn, biostatistician 4,
  8. Adrian Palfreeman, consultant in genitourinary medicine8,
  9. Richard Gilson, consultant physician and senior clinical lecturer9,
  10. Brian Gazzard, professor of medicine and director of HIV clinical research10,
  11. Teresa Hill, research fellow5,
  12. John Walsh, consultant in HIV and sexual health11,
  13. Martin Fisher, consultant physician in HIV and genitourinary medicine12,
  14. Chloe Orkin, consultant HIV physician13,
  15. Jonathan Ainsworth, consultant HIV physician14,
  16. Loveleen Bansi, research statistician5,
  17. Andrew Phillips, professor of epidemiology5,
  18. Clifford Leen, honorary professor of medicine, consultant physician in infectious diseases15,
  19. Mark Nelson, consultant physician10, senior lecturer16,
  20. Jane Anderson, consultant physician, director of the centre for the study of sexual health and HIV17,
  21. Caroline Sabin, professor of medical statistics and epidemiology5
  1. 1School of Social and Community Medicine, Bristol University, Bristol BS8 2PS, UK
  2. 2HIV Service, North Bristol NHS Trust, Bristol
  3. 3HIV and STI Department, Health Protection Services, Health Protection Agency, London
  4. 4Medical Research Council Clinical Trials Unit, London
  5. 5University College London, London
  6. 6King’s College London, London
  7. 7Royal Free Hospital NHS Trust, London
  8. 8Leicester Royal Infirmary, Leicester
  9. 9UCL Centre for Sexual Health and HIV Research, Mortimer Market Centre,  London
  10. 10Chelsea and Westminster Hospital, London.
  11. 11Imperial College Healthcare Trust, London
  12. 12Brighton and Sussex University Hospitals, Brighton
  13. 13Barts and The London School of Medicine and Dentistry, London
  14. 14North Middlesex University Hospital, London
  15. 15Western General Hospital, Edinburgh
  16. 16Imperial College School of medicine, London
  17. 17Homerton University Hospital NHS Foundation, London
  1. Correspondence to: M May m.t.may{at}bristol.ac.uk
  • Accepted 24 August 2011

Abstract

Objectives To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm3 at start of antiretroviral therapy.

Design Cohort study.

Setting Outpatient HIV clinics throughout the United Kingdom.

Population Adult patients from the UK Collaborative HIV Cohort (UK CHIC) Study with CD4 count ≤350 cells/mm3 at start of antiretroviral therapy in 1996-2008.

Main outcome measures Life expectancy at the exact age of 20 (the average additional years that will be lived by a person after age 20), according to the cross sectional age specific mortality rates during the study period.

Results 1248 of 17 661 eligible patients died during 91 203 person years’ follow-up. Life expectancy (standard error) at exact age 20 increased from 30.0 (1.2) to 45.8 (1.7) years from 1996-9 to 2006-8. Life expectancy was 39.5 (0.45) for male patients and 50.2 (0.45) years for female patients compared with 57.8 and 61.6 years for men and women in the general population (1996-2006). Starting antiretroviral therapy later than guidelines suggest resulted in up to 15 years’ loss of life: at age 20, life expectancy was 37.9 (1.3), 41.0 (2.2), and 53.4 (1.2) years in those starting antiretroviral therapy with CD4 count <100, 100-199, and 200-350 cells/mm3, respectively.

Conclusions Life expectancy in people treated for HIV infection has increased by over 15 years during 1996-2008, but is still about 13 years less than that of the UK population. The higher life expectancy in women is magnified in those with HIV. Earlier diagnosis and subsequent timely treatment with antiretroviral therapy might increase life expectancy.

Footnotes

  • This work was presented in part at the Tenth International Congress on Drug Therapy in HIV Infection Glasgow, UK, 7-11 November 2010.36

  • Contributors: MM conceived the study design, analysed the data, and wrote the first draft of the paper. MG contributed to study design and writing the first draft of the paper. LB was responsible for data management. All clinician authors were involved in data collection at study sites. All authors contributed to data interpretation and the final text. CS is principal investigator of UK CHIC Study and coordinated the study. MM, CS, and LB had full access to all the data in the study. MM had the final responsibility for the decision to submit for publication and is guarantor.

  • Funding: The UK CHIC Study is funded by the UK Medical Research Council (grant G0000199 and G0600337). MM is also funded by the UK Medical Research Council (grant G0700820). The views expressed in this manuscript are those of the researchers and not necessarily those of the Medical Research Council. The funders had no role in carrying out the study or in the decision to submit the manuscript for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The project was approved by a multicentre research ethics committee and by local ethics committees.

  • Data sharing: No additional data available.

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