Abstract:
Background Health care for people living with HIV has improved substantially in the past two decades. Robust
estimates of how these improvements have affected prognosis and life expectancy are of utmost importance to
patients, clinicians, and health-care planners. We examined changes in 3 year survival and life expectancy of patients
starting combination antiretroviral therapy (ART) between 1996 and 2013.Lancet HIV 2017; 4: e349–356
Methods We analysed data from 18 European and North American HIV-1 cohorts. Patients (aged ≥16 years) were
eligible for this analysis if they had started ART with three or more drugs between 1996 and 2010 and had at least
3 years of potential follow-up. We estimated adjusted (for age, sex, AIDS, risk group, CD4 cell count, and HIV-1 RNA
at start of ART) all-cause and cause-specific mortality hazard ratios (HRs) for the first year after ART initiation and the
second and third years after ART initiation in four calendar periods (1996–99, 2000–03 [comparator], 2004–07,
2008–10). We estimated life expectancy by calendar period of initiation of ART.See Comment page e324
Published Online
May 10, 2017
http://dx.doi.org/10.1016/
S2352-3018(17)30066-8
*Members listed at end of paper
Correspondence to:
Mr Adam Trickey, School of
Social and Community Medicine,
University of Bristol,
Bristol BS8 2PS, UK
adam.trickey@bristol.ac.uk
Findings 88 504 patients were included in our analyses, of whom 2106 died during the first year of ART and 2302 died
during the second or third year of ART. Patients starting ART in 2008–10 had lower all-cause mortality in the first year
after ART initiation than did patients starting ART in 2000–03 (adjusted HR 0·71, 95% CI 0·61–0·83). All-cause
mortality in the second and third years after initiation of ART was also lower in patients who started ART in 2008–10
than in those who started in 2000–03 (0·57, 0·49–0·67); this decrease was not fully explained by viral load and CD4 cell
count at 1 year. Rates of non-AIDS deaths were lower in patients who started ART in 2008–10 (vs 2000–03) in the
first year (0·48, 0·34–0·67) and second and third years (0·29, 0·21–0·40) after initiation of ART. Between 1996 and 2010,
life expectancy in 20-year-old patients starting ART increased by about 9 years in women and 10 years in men.
Interpretation Even in the late ART era, survival during the first 3 years of ART continues to improve, which probably
reflects transition to less toxic antiretroviral drugs, improved adherence, prophylactic measures, and management of
comorbidity. Prognostic models and life expectancy estimates should be updated to account for these improvements.
