A “major shift” in healthcare training on HIV and ageing, along with more integration between primary care and specialist services, are needed following dramatic improvements in life expectancy for those with the virus, a charity has said.
The call comes in response to a study showing life expectancy for patients with HIV has increased by 10 years in the West since the introduction of antiretroviral therapy (ART) in the mid-1990s.
“This is great news. However, it also means we’re entering uncharted territory”
Their projections suggest a 20-year-old who began treatment from 2008 onwards and had a low viral load after a year of treatment may live as long as the average for the general population – around 78.
However, they noted that life expectancy for people with HIV mostly remains lower than that of the general population.
The UK study authors suggested their findings could encourage those diagnosed to start treatment as soon as possible and continue it fully.
The study, published in journal The Lancet HIV, used data for 88,504 people with HIV who started ART between 1996 and 2010 from 18 European and North American studies.
Researchers tracked how many people died during the first three years of treatment, their cause of death, HIV viral load, immune cell count and whether they were infected through injecting drugs.
Fewer patients who started treatment between 2008-10 died during their first three years of treatment than who started treatment between 1996-2007.
“Now we need to focus on the issues surrounding drug adherence, late diagnosis of HIV, and diagnosis”
When looking specifically at deaths due to AIDS, the number during treatment declined over time between 1996 and 2010 – probably because newer drugs are more effective in restoring the immune system.
During this time, measures of HIV improved – with the average immune cell count after a year of treatment increasing from 370 cells per microlitre of blood in 1996-1999, to 430 cells per microlitre in 2008-2010, while the proportion of people with a low HIV viral load increased from 71% to 93%.
As a result of these improvements, between 1996 and 2013, the life expectancy of 20-year-olds treated for HIV increased by nine years for women and 10 years for men in the European Union and North America.
Projections based on death rates in the second and third year of treatment for Europeans and Americans, estimated that 20-year-olds starting therapy during 2008-10 who survived the first year of treatment would live to 73 for men and 76 for women.
However, the researchers cautioned that the improvements were not seen in all people with HIV, with life expectancy of those infected through injecting drugs not increasing as much.
“The concern is greatest in the world’s most vulnerable populations”
Adam Trickey, lead study author from the University of Bristol, said: “Our research illustrates a success story of how improved HIV treatments coupled with screening, prevention and treatment of health problems associated with HIV infection can extend the lifespan of people diagnosed with HIV.
“Combination antiretroviral therapy has been used to treat HIV for 20 years, but newer drugs have fewer side effects, involve taking fewer pills, better prevent replication of the virus and are more difficult for the virus to become resistant to,” he noted.
However, Mr Trickey highlighted that deaths in people living with HIV were unlikely to be reduced by further development of drugs.
“Now we need to focus on the issues surrounding drug adherence, late diagnosis of HIV, and diagnosis and treatment of co-occurring conditions,” he said.
Dr Michael Brady, medical director at Terrence Higgins Trust, said the study findings were “great news”, but also meant “we’re entering uncharted territory”.
“As it stands, the healthcare, social care and welfare systems simply aren’t ready to support the increasing numbers of people growing older with HIV,” he said.
“We need a new model of care to better integrate primary care with HIV specialist services, and we need a major shift in awareness and training around HIV and ageing,” said Dr Brady.
He added: “We must also continue to increase testing and diagnose people who are unaware they have the virus.
“Currently one in seven people with HIV remain undiagnosed, and these people are missing out on the treatment that could enable them to live into a long and healthy old age,” he said.
In a linked comment piece on the study, Ingrid Katz, from the Brigham and Women’s Hospital in the US, said: “The introduction of combination ART has been one of the great public health success stories of the past 40 years.
But she added: “The concern is greatest in the world’s most vulnerable populations, which include people who inject drugs in Europe and North America, and individuals living in resource-constrained settings globally, where access to early ART initiation has been limited.”
The study was funded by the UK Medical Research Council, UK Department for International Development and the EU EDCTP2 programme.