Continued survival improvement in HIV infection


Patients from 18 European and North American HIV cohorts were included in an analyses of the mortality during the first three years after initiation of antiretroviral therapy (ART). Four calendar periods were compared;1996-99, 2000-03, 2004-07 and 2008-10. The study included almost 90,000 participants. 2,106 patients died during the first year of therapy and 2,302 died during the second and third year. During the first year of therapy mortality was similar between 1996 and 2007, but lower during 2008-2010. Survival during the second and third year of ART improved consistently throughout the observation period. Both AIDS-related and non-AIDS-related deaths decreased. The adjusted hazard ratios for all-cause mortality during the second and third year was 0.8 for the last calendar period compared to 1.12 (1996-99), 1.0 (2000-03) and 0.93 (2004-07). The decline in mortality was lower in people who inject drugs than in other groups. From 1996 to 2010 the projected life expectancy increased 10 years in a 20 year old person starting ART.

The Antiretroviral Therapy Cohort Collaboration. Lancet HIV 2017;Published online May 10, 2017

Comment: Survival in HIV continues to improve. Even after adjusting for CD4 count, age, sex, risk group and viral load there is a continuous improvement. Taking the results of the START study into account where it was shown that there was a survival benefit with immediate therapy compared to deferred therapy it seems likely that life expectancy in HIV infected individuals will improve further and closely approach the life expectancy of the general population.