HIV Death Gap Closing
Near-Normal Life Span With Early HIV Detection, Treatment
July 1, 2008 -- HIV infection no longer has to mean AIDS or even early death.
There's still a death gap. People with HIV die sooner than people not infected with the AIDS virus. But that gap is closing for people who start medical care very soon after HIV infection and who get state-of-the-art HIV treatment.
The finding comes from a study of 16,534 Western Europeans with known dates of HIV infection ranging from 1981 to 2006. Researchers Kholoud Porter, PhD, and colleagues compared the life expectancy of these people with HIV infection to age- and sex-matched individuals without HIV infection.
Before 1996, when highly active antiretroviral therapy (HAART) became available, the findings were grim.
"When we just looked at pre-1996, before the HAART era, we would have expected to see 56 deaths, and actually we saw over 1,300 deaths," Porter tells WebMD. "That gap narrowed and narrowed over time, so in 2004-2006 we observed 127 deaths where we would have expected 37 deaths. It is quite a dramatic decline, but still there are excess deaths."
People infected with HIV in the last five years, whatever their age, do not die sooner than their uninfected peers. But with longer duration of infection, HIV is linked to a higher risk of death.
Women live longer than men do, but even accounting for this disparity, women with HIV infection live longer than men with HIV infection. People who get HIV infection from intravenous drug use tend to die sooner than people who get HIV infection via sexual intercourse.
Astonishing to people who remember the early years of the HIV epidemic is the finding that people with HIV who get state-of-the-art treatment are unlikely to die of AIDS.
"We know that over time, people with HIV aren't getting AIDS as much, because they are getting treatment before they get down to those dangerous levels of immune suppression," Porter says. "But we are still getting deaths. There are non-AIDS-defining causes of death that may be related to immune suppression. People are still dying of HIV disease itself; it is just not defined as AIDS."
That's true, says Margaret Fischl, MD, director and principal investigator of the AIDS Clinical Research Unit at the University of Miami. Fischl has treated people with AIDS since the earliest years of the epidemic. She led the first clinical trial to show that an anti-HIV drug, AZT, could slow what was then the relentless progression of HIV disease to AIDS and death.
"We know that antiretroviral therapy is effective and can reverse the damage this virus does. And therefore AIDS per se does not occur," Fischl tells WebMD. "Are we beginning to see HIV-related, non-AIDS events? Are we seeing more heart attacks in treated patients? Is it HIV related? Are people getting other malignancies and cancers instead of those traditionally linked to AIDS? Those questions are being asked right now."