Life expectancy of people with HIV on antiretroviral therapy in Spain

Abstract

Objective: To estimate life expectancy of people with HIV (PWH) and describe causes of death. Design: Antiretroviral therapy (ART)-naive adults from the CoRIS cohort starting ART in 2004–2019. Methods: We calculated life expectancy at age 40 for men and women according to their ART initiation period, and stratified by transmission category, CD4+ cell count and AIDS diagnosis. We estimated life expectancy in 10-year age bands using life tables constructed from mortality rates, estimated through Poisson models. Results: Life expectancy increased from 65.8 [95% confidence interval (CI) 65.0–66.6] in 2004–2008 to 72.9 (72.2–73.7) in 2014–2019 in men [general population comparators (GPC): 79.1 and 81.2 years, respectively] and from 65.8 (65.0–66.6) to 72.5 (71.8–73.3) in women (GPC: 84.9 and 86.4, respectively). Non-AIDS-related deaths accounted for 68% of deaths among men and 78% among women. Life expectancy was longer when starting ART with higher CD4+ cell counts and without AIDS. For men acquiring HIV through sex with men, starting ART in 2014–2019 without AIDS, life expectancy was 75.0 (74.2–75.7) with CD4+ cell count less than 200 cells/μl, rising to 78.1 (77.5–78.8) with CD4+ cell count at least 350 cells/μl. Corresponding figures were 70.1 (69.4–70.9) and 76.0 (75.3–76.7) for men acquiring HIV heterosexually (HTX) and 61.5 (60.7–62.3) and 69.0 (68.2–69.8) for those acquiring HIV through injection drug use (IDU). For women starting ART from 2014 without AIDS, life expectancy increased from 71.7 (71.0–72.4) to 77.3 (76.7–77.9) among HTX and from 63.7 (62.9–64.5) to 70.7 (70.0–71.5) among IDU. Conclusion: Our findings confirm the progressive improvement of life expectancy in PWH in Spain over the last decades, supporting the insurability of PWH on suppressive ART in our current setting and time.