. Racial and sex disparities in life expectancy losses among HIV-infected persons in the United States: impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy.
Open accessAbstract
BACKGROUND: Most persons with human immunodeficiency virus (HIV) infection in the United States present to care with advanced disease, and many patients discontinue therapy prematurely. We sought to evaluate sex and racial/ethnic disparities in life-years lost as a result of risk behavior, late presentation, and early discontinuation of HIV care, and we compared these survival losses for HIV-infected persons with losses attributable to high-risk behavior and HIV disease itself. METHODS: With use of a state-transition model of HIV disease, we simulated cohorts of HIV-infected persons and compared them with uninfected individuals who had similar demographic characteristics. We estimated non-HIV-related mortality with use of risk-adjusted standardized mortality ratios, as well as years of life lost because of late presentation and early discontinuation of antiretroviral therapy (ART) for HIV infection. Data from the national HIV Research Network, stratified by sex and race/ethnicity, were used for estimating CD4+ cell counts at ART initiation. RESULTS: For HIV-uninfected persons in the United States who have risk profiles similar to those of individuals with HIV infection, the projected life expectancy, starting at 33 years of age, was 34.58 years, compared with 42.91 years for the general US population. Those with HIV infection lost an additional 11.92 years of life if they received HIV care concordant with guidelines; late treatment initiation resulted in 2.60 additional years of life lost, whereas premature ART discontinuation led to 0.70 more years of life lost. Losses from late initiation and early discontinuation were greatest for Hispanic individuals (3.90 years). CONCLUSIONS: The high-risk profile of HIV-infected persons, HIV infection itself, as well as late initiation and early discontinuation of care, all lead to substantial decreases in life expectancy. Survival disparities resulting from late initiation and early discontinuation of therapy are most pronounced for Hispanic HIV-infected men and women. Interventions focused on risk behaviors, as well as on earlier linkage to and better retention in care, will lead to improved survival for HIV-infected persons in the United States.
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HIV infection accelerates aging, and illnesses typical of the elderly are highly frequent among HIV-infected individuals even when therapy suppresses the virus below detection limits.
“There is an emerging consensus in the scientific community that HIV infection hastens the process of aging and that illnesses that appear typically in the elderly are highly frequent among HIV-infected individuals, even in those with therapy-induced suppression of the virus below detection limits [59,60].”
From T-cell aging in rheumatoid arthritis (2014) · cites this paper as [60]
Compared to behaviorally and demographically similar HIV-uninfected individuals, people with HIV infection, even those receiving effective ART with suppression of virus to levels below typical detection limits, experience excess morbidity and mortality.
“When compared to behaviorally and demographically similar HIV-uninfected individuals, people with HIV infection, even those receiving effective ART with suppression of virus to levels below typical detection limits, experience excess morbidity and mortality (3,4).”
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Self-citation
- Authors
- Losina, E., Schackman, B. R., Sadownik, S. N., Gebo, K. A., Walensky, R. P., Chiosi, J. J., Weinstein, M. C., Hicks, P. L., Aaronson, W. H., Moore, R. D., Paltiel, A. D., & Freedberg, K. A.
- Affiliations
- Boston University (US)
- Weill Cornell Medicine (US)
- Johns Hopkins University (US)
- Corresponding author
- Losina, Elena
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11-15
- Volume
- 49
- Issue
- 10
- Pages
- 1570-1578
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC2783631
- OpenAlex
- W2139380417
- Cited by
- 180
- References
- 61
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 1 · 2022: 8 · 2021: 7 · 2020: 1 · 2019: 7 · 2018: 9 · 2017: 10 · 2016: 12 · 2015: 18 · 2014: 16 · 2013: 27 · 2012: 28
- FWCI
- 12.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (R01AA016893)
- National Institute of Mental Health (R01MH065879, R01MH065869, MH065879)
- National Institute on Drug Abuse (U01DA036935, K01DA017179, K24DA000432, K23DA000523)
- National Institute of Allergy and Infectious Diseases (K24AI062476, R37AI042006, K23AI001794, U01AI069918, P30AI060354, K25AI050436)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Keywords
- HIV infection, life expectancy, years of life lost, racial and ethnic disparities, sex disparities, late HIV diagnosis, risk-taking, Hispanic population, state transition model, linkage to care, retention in care
- MeSH terms
- Adult, Female, Humans, Life Expectancy, Male, Patient Compliance, Risk-Taking, Sex Factors, United States, HIV Infections, Survival Analysis, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Racial Groups
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