Hurdles to HIV Survival
Why are so many patients still dying too young?
Roisin McGuigan |
A recent study in The Lancet has reported that – thanks to the latest HIV drugs – young adults with the virus can now enjoy a near-normal life expectancy. Today, a 20-year-old who began antiretroviral therapy (ART) in the last few years is estimated to live 10 years longer than a 20-year-old who began ART between 1996 and 1999. But for many patients, barriers to treatment prevent access to this increased life expectancy.
“I became involved in studying HIV survival in the first job I had after my master’s degree,” says Adam Trickey, lead author of the associated paper (1). “The Antiretroviral Therapy Cohort Collaboration is one of the largest HIV cohorts in the world, an enormous network across the US and Europe that has been running for more than a decade and contains over 100,000 patients – so I leapt at the opportunity to work with them,” he says. “Despite being new to the field when I started working on this paper, I was able to quickly learn the ropes as my many co-authors are all world-leading academics and clinicians in this area, with thousands of peer-reviewed publications between them.”
Trickey and his colleagues analyzed data from 18 European and North American cohorts – a total of just over 88,500 patients. Some of the barriers to treatment they observed included high financial costs, people being unaware that they had HIV, and the stigma associated with HIV, which prevented people from attending treatment centers for fear of discovery.
For patients who did have access to treatment, adherence was another potential issue. “Survival appeared to improve for all groups of HIV positive people, with the exception of those who contracted the disease through injecting drug use, which tends to be a marker of social marginalization,” says Trickey. “Other research has shown that this group tend to have worse adherence to treatment programs and more comorbidities, suggesting the need for interventions increasing access to opioid substitution therapy and treatment for Hepatitis C virus infection.”
Another factor affecting life expectancy was how soon people started treatment. The research team estimated that those who had a high CD4 cell count one year after starting treatment – indicating that they started treatment early ¬– had a life expectancy approaching that of the HIV negative population.
“Today's antiretroviral drugs are clearly very effective, and more efforts and funding should be invested at both national and regional levels to provide this treatment for all people living with HIV,” says Trickey, adding that focusing on screening could make a big difference; those people not receiving treatment account for the majority of AIDS-related deaths.
Research also indicates that there is another gain to public health to be made: those who receive treatment are far less likely to transmit the virus to others.
“I hope that our research reduces the stigma suffered by people living with HIV and increases the awareness amongst the HIV-positive population that by starting treatment and adhering to the regimens prescribed by their clinicians, they are likely to live a longer life,” adds Trickey.
- Antiretroviral Therapy Cohort Collaboration, “Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies”, Lancet HIV, [Epub ahead of print], 2017. PMID: 28501495.