People living with HIV in South Africa, who access antiretroviral therapy (ART) before their immune systems are severely compromised, have life expectancies close to that of the general population, researchers have found.
Published this week in the journal PLOS Medicine, the research shows that the life expectancies (additional years of life) are around 80% of that of the general population, provided those with HIV initiate treatment before their CD4 count (a measure of the strength of the immune system at the time of starting treatment) drops below 200.
The findings could impact on the cost of life insurance (reducing it) and epidemiological modeling estimates, which typically assume that life expectancy after starting ART is around 10 years.
Lead researcher from the University of Cape Town Leigh Johnson and colleagues collected information from six HIV treatment programs in South Africa between 2001 and 2010.
The survival model shows that – as in HIV-negative adults – the most significant factor determining life expectancy of patients starting HIV treatment was their age when they started treatment.
The average life expectancy (additional years of life) of men starting ART varied between 27.6 years at age 20 and 10,1 years at age 60. Corresponding estimates in women were 36,6 at 20 and 14,4 years at 60.
The UCT researchers also found that life expectancies were significantly influenced by baseline CD4 counts. Life expectancies in patients with baseline CD4 counts of 200 cells per microliter or more were between 70% and 86% of those HIV negative adults of the same age and sex, while patients starting ART with CD4 counts of less than 50 had life expectancies that were between 48% and 61% of those of HIV-negative adults.
The study showed that risk of death was highest during the first year after starting ART, because of the delay between the start of treatment and the recovery of the immune system.
Johnson says the study did show that many HIV patients are still starting treatment at very low CD4 counts, and health services must overcome major challenges, such as late diagnosis, low uptake of CD4 testing, loss from care, and delayed ART initiation, if near normal life expectancies are to be achieved for the majority of people with HIV in South Africa.
They warned that the risk of rising levels of HIV drug resistance could compromise treatment effectiveness.
The researchers said their finding made it imperative to find funding systems and innovative ways to reduce the costs of ART, ensuring the long-term sustainability of treatment, especially in low- and middle-income countries.