U.S. Women and Black and Hispanic Men Have Shorter Life Expectancy after HIV Diagnosis

		SUMMARY: In the U.S., life expectancy after an HIV diagnosis has approximately doubled since the advent of effective combination antiretroviral therapy (ART), from 11 years in 1996 to 23 years in 2005, Centers for Disease Control and Prevention (CDC) researchers reported in the January 2010 Journal of Acquired Immune Deficiency Syndromes. However, national HIV surveillance data show that women do not live as long as men, and black and Hispanic men die sooner than white men.

By Liz Highleyman

Kathleen McDavid Harrison with the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and colleagues estimated life expectancy and average years of life lost after an HIV diagnosis using population-based surveillance data for adults (age 13 years or older) from 25 states that have used name-based HIV surveillance since 1996. The analysis therefore excluded some states with large HIV/AIDS caseloads -- including California and New York -- that used anonymous reporting for part of this period.

The researchers modeled life expectancy after an HIV diagnosis using a life table approach. They then compared life expectancy of people with HIV to that of the general population matched for age, sex, and race/ethnicity during the same calendar year using vital statistics data from the National Center for Health Statistics. Comparing the 2 figures allowed them to estimate years of life lost.

Results

	A total of 220,646 people were diagnosed with HIV in the 25 states between 1996 and 2005.
	A total of 10,366 deaths from any cause occurred (reported through the end of 2007).
	74% of newly diagnosed individuals were male.
	By race/ethnicity, blacks accounted for 55% of those diagnosed, whites for 36%, and Hispanics/Latinos for 9% (there was too little data for Asians, Pacific Islanders, American Indians, and Alaska and Hawaii Natives to allow for stable estimates).
	One-third were diagnosed late, with a CD4 count < 200 cells/mm3 on their first test within 6 months after diagnosis.
	Among newly diagnosed males, 67% were exposed through male-to-male sexual contact, 16% through injection drug use, 10% through heterosexual contact, and 7% were both gay/bisexual men and injection drug users.
	Among females, 70% were exposed through heterosexual contact, 29% through injection drug use, and 2% with unknown transmission route.
	Overall, average life expectancy after HIV diagnosis increased from 10.5 years in 1996 to 22.5 years in 2005.
	The largest 1 year increase was from 1996 to 1997, when combination ART using protease inhibitors came into widespread use.
	Life expectancy was longer for females than for males overall, but improved less over time:
	Females: from 12.6 years in 1996 to 23.6 in 2005; Males: from 9.9 years in 1996 to 22.0 years in 2005.
	In 2005, life expectancy was longest for white men (25.5 years), followed by Hispanic men (22.6 years), then black men (19.9 years).
	During the 2000-2005 period, Hispanic women had the longest life expectancy (24.2 years), followed by white women (22.1 years), then black women (20.6 years).
	Over the period as a whole, men who have sex with men and women who acquired HIV through heterosexual contact had longer life expectancies than injection drug users.
	As life expectancy increased, average years of life lost declined, from 32.9 years in 1996 to 21.2 years in 2005 (19.1 years for males, 22.7 years for females).

Based on these findings, the researchers concluded, "Disparity in life expectancy for females and both black and Hispanic males, compared with males and white males, respectively, persists and should be addressed."

"Significant improvements were...experienced among all race/ethnic groups and by both males (12 years) and females (11 years)," they elaborated in their discussion. "Also to be celebrated are the overall increases in life expectancy. Unfortunately, disparity in life expectancy for black and Hispanic males, compared with white males, persists."

"Given the findings, further promotion of [HIV] testing initiatives and opt-out testing will be paramount to increasing the proportion of persons who are aware of their HIV infections and who then reduce behavioral risk factors to slow the transmission of HIV," they recommended. "Programs aimed at increasing access to care of HIV-infected persons may improve the proportion of persons being treated and thus lengthen survival."

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

2/2/10

Reference
K McDavid Harrison, R Song, and X Zhang. Life Expectancy After HIV Diagnosis Based on National HIV Surveillance Data From 25 States, United States. Journal of Acquired Immune Deficiency Syndromes 53(1): 124-130 (Abstract).