Boston, Massachusetts (PressExposure) November 12, 2009 -- Over the past decade, treatment with antiretroviral therapy (ART) has produced striking survival gains for those infected with the human immunodeficiency virus (HIV) in the United States. Yet the benefits in survival appear to differ by both gender and ethnicity, according to researchers from Brigham and Women's Hospital (BWH), Massachusetts General Hospital (MGH) and their colleagues. The study is based on a comprehensive computer simulation model of HIV developed by the "Cost-effectiveness of Preventing AIDS Complications ("CEPAC") team, and was led by Elena Losina, PhD, researcher at BWH. These findings appear online in Clinical Infectious Diseases and in the November 15, 2009 print issue.
Having identified an effective therapy for HIV, many of the current challenges for treatment now focus on HIV testing and linking people to care, as well as helping them to remain in care after beginning therapy. The goal of the study was to assess survival with effective HIV therapy, compared to survival in people without HIV.
The researchers used the CEPAC model, which employs the most up-to-date data on HIV disease and therapy to forecast disease progression and survival. They found that for people in the United States living without HIV, life expectancy beginning at age 33 is an additional 43 years. High risk behavior, such as substance abuse, on average, accounts for an 8 year reduction in life expectancy. HIV infection itself reduces life expectancy by an additional 12 years and a late start or premature discontinuation of HIV treatment further reduces life expectancy by 23 years.
Researchers also found that reduction in life expectancy in HIV-infected individuals differ between race and sex, with an overall higher risk for HIV contraction in women. Such differences are mostly due to differential risk profiles as well as different time of ART initiation and prematurely stopping treatment. Furthermore, the impact of risk behaviors appeared greater in Hispanic and Black women with HIV, with these women experiencing greater survival losses than White women with HIV. "These disparities highlight the need to focus more attention on those in the higher at-risk groups for contracting HIV, and emphasizing care for those with HIV and are part of the populations that are not receiving immediate and long-term care," said Dr. Losina.
"There is a critical need for people with HIV to begin care in a timely way and to remain in care," adds Kenneth A. Freedberg, MD, MSc, director of the HIV Clinical Research Program at MGH, and senior study author of the report. . "HIV testing for all adults in the United States, as currently recommended, with effective linkage to care, will have important survival benefits."
Study co-authors include Bruce Schackman, PhD from Weill-Cornell Medical College, Sara Sadownick, MPH, Rochelle P. Walensky, MD, MPH, John Chiosi, Wendy Aaronson, MPH, from Massachusetts General Hospital, Kelly A. Gebo, MD, MPH, Perrin L. Hicks and Richard D. Moore, MD, MPH from Johns Hopkins University School of Medicine, Milton C. Weinstein, PhD from Harvard School of Public Health, and A. David Paltiel, PhD from Yale University School of Medicine.
The study was funded by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute on Drug Abuse, the Agency for Healthcare Research and Quality, the Doris Duke Charitable Foundation, and Johns Hopkins University.