Current treatment with antiviral drugs has changed a previously fatal disease into a chronic condition where those infected can expect to live a normal and healthy life for many years.
Forward projections from a number of large cohorts have, however, suggested that with current treatment regimens patients may still have a slightly shorter life expectancy than uninfected persons. This is because patients with HIV appear to experience diseases associated with aging such as heart attacks, diabetes and cancer at a younger age,
A recent study from a UK-based large cohort by May and colleagues confirm these projections with men expected to do worse than women. They estimated that for an average 20 year old man HIV decreases life expectancy by 18.1 years compared with 11.4 years for women. This may reflect life-style differences between the sexes (alcohol, smoking) but may also be because women of child-baring age are more likely to be diagnosed early during routine antenatal screening.
Their study showed that persons starting antiviral therapy with a low CD4 count of less than 100 – which is sign of severe immunological damage – rather than earlier (CD4 200-350) lose over 15 years of life. Currently guidelines recommend starting antiviral therapy when the CD4 falls at or below 350.
While there are problems with making accurate projections into the future this research further highlights the importance of routinely offering and testing for HIV at all clinical settings in order to identify the infection early and before any significant immunological damage has taken place.
See BMJ 2011:343-d6016