Impact on life expectancy of HIV-1 positive individuals of CD4R cell count and viral load response to antiretroviral therapy

Margaret T. May*, Mark Gompels, Valerie Delpech, Kholoud Porter, Chloe Orkin, Stephen Kegg, Phillip Hay, Margaret Johnson, Adrian Palfreeman, Richard Gilson, David Chadwick, Fabiola Martin, Teresa Hill, John Walsh, Frank Post, Martin Fisher, Jonathan Ainsworth, Sophie Jose, Clifford Leen, Mark NelsonJane Anderson, Caroline Sabin, Abdel Babiker, Daviad Dunn, Brian Gazzard, Andrew Phillips, Deenan Pillay, Memory Sachikonye, Achim Schwenk, Alan Winston, Nicky Mackie, Susie Huntington, Alicia Thornton, Adam Glabay

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

459 Citations (Scopus)

Abstract

Objective: The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART). Methods: Patients aged more than 20 years who started ART during 2000-2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012.Wedetermined the latestCD4+ cell count and viral load before ART and in each of years 1-5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4+ cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20-85 years. Results: Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 personyears. At start of ART, expected age at death [95% confidence interval (CI)] of 35-yearold men with CD4+ cell count less than 200, 200-349, at least 350 cells/ml was 71 (68- 73), 78 (74-82) and 77 (72-81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five-year-old men who increased their CD4+ cell count in the first year of ART from less than 200 to 200-349 or at least 350 cells/ml and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48-61) (CD4+ cell count <200 cells/ml and no viral suppression) to 80 (76-83) years (CD4+ cell count 350 cells/ml and viral suppression). Conclusion: Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4+ cell count significantly improve their life expectancy if they have a good CD4+ cell count response and undetectable viral load.

Original languageEnglish
Pages (from-to)1193-1202
Number of pages10
JournalAIDS
Volume28
Issue number8
DOIs
Publication statusPublished - 2014

Bibliographical note

Publisher Copyright:
© 2014 Wolters Kluwer Health - Lippincott Williams & Wilkins.

Keywords

  • Antiretroviral therapy
  • Cd4<sup>+</sup> cell count
  • HIV
  • HIV-1 RNA
  • Life expectancy
  • Viral load

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