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Author Topic: People with HIV have 21-year reduction in life expectancy in US  (Read 4590 times)

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Offline Rev. Moon

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People with HIV have 21-year reduction in life expectancy in US
« on: September 08, 2009, 03:04:49 PM »
Not the most upbeat or uplifting sort of news/research.  Not fully convinced here about this study, as there appear to be some variables that were missing or not fully accounted for.

People with HIV have 21-year reduction in life expectancy in US.  (Posted 08-Sept-2009, Aidsmap.com)

http://aidsmap.com/en/news/594FA817-F6A3-4CAA-9051-22A1FB71F25B.asp

Quote
Despite dramatic increases in life expectancy in the decade since the introduction of combination therapy, Americans diagnosed with HIV are still dying an average of 21 years younger than their HIV-negative peers, report researchers from the Centers of Disease Prevention and Control in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Although womenís life expectancy is longer than menís, it has not improved as much as menís, and the situation of black and Hispanic men is significantly worse than that of white men.

A number of cohort studies have already provided strong evidence of important declines in the risk of death amongst people with HIV in developed countries since combination therapy became available. Moreover, attention has often been drawn to the long life expectancy of some groups of people with HIV, especially those diagnosed at a young age.

However studies have also continued to find poorer outcomes than among HIV-negative people. One study of over 43,000 patients in 14 cohorts found that whilst a 20 year old starting treatment could expect to live to be 63, this life expectancy was only two-thirds of that in the general population.

Another study, this time based on over 16,000 people in 23 European cohorts, found that whilst mortality rates were similar to the general population in the first five years after diagnosis, an increased risk of death became apparent with longer-term infection.

Studies have also identified groups of people with HIV who tend to have a poorer prognosis, including injecting drug users, older people, those co-infected with hepatitis C, and people whose CD4 cell count is low when starting treatment.

The new study is based on routine anonymised data collected on people newly diagnosed with HIV. Other studies have used data on people with HIV who are accessing treatment or care, which may somewhat over-estimate life expectancy.

Data was provided by 25 of 50 states, representing approximately a quarter of Americans living with HIV. Some key states such as New York and California are not included, and Hispanic people are under-represented in the sample. Diagnoses between 1996 and 2005 were included, with follow-up until 2007.

Over 22,000 people were included in the study, of whom 10,366 died.

Life expectancy
On average, life expectancy after diagnosis increased from 10.5 years in 1996 to 22.5 years in 2005. HIV-positive women, overall, had a longer life expectancy than men (23.6 years for women in 2005, compared to 21.8 years for men).

Among men, the greatest improvements in life expectancy were experienced by white men. Black men diagnosed in 2005 could expect to live for five years less than their white counterparts.

Because there are fewer women in the sample, the estimates for life expectancy for women of a particular ethnicity diagnosed in a single year are not particularly accurate. The researchers therefore provide pooled figures for the years 2001 to 2005. These show that black women have a shorter life expectancy than other groups, with the greatest improvements in life expectancy being experienced by Hispanic women.

However the authors note that the most important improvements in life expectancy took place in the first five years of the study, and increases have slowed since then.

 
Life-expectancy was longer for gay and bisexual men (28.3 years in 2005) than for other men. Injecting drug users had the shortest life expectancy (15.2 years for men, and 15.9 years for women in 2005).

Average years of life lost
The authors also calculated how many years a personís life is shortened, in comparison with a person of the same age, sex and ethnicity in the general population.

In interpreting these figures, it is important to note that there may be higher rates of substance use, hepatitis C co-infection and socio-economic problems in people with HIV than in the general population. These factors will also contribute to the lower life expectancy.

Moreover, the particular nature of the healthcare system in the United States may mean that different results would be seen in other developed countries.

Comparing the life expectancy of people diagnosed with HIV in 2005 with that in the general population, it was 21.1 years shorter.

Men could expect to die an average of 19.1 years before their HIV-negative peers, but this figure varies by age. A man diagnosed aged 20 would die 25 years early, a 40-year old 18 years early and a 60-year old 10 years early.

HIV-positive womenís life expectancy was an average 22.7 years less than in the general population, with more variation according to age. A woman diagnosed aged 20 would die 31 years early, a 40-year old 21 years early and a 60-year old 11 years early.

The greatest number of years lost was seen in Hispanic people, followed by blacks and whites. The authors note that other data show that Hispanics have high rates of discontinuation of treatment and of late presentation to care, which may account for premature deaths.

Conclusions
The authors believe that as well as being useful for policy makers, ďthese results can guide clinician communication with patients about their life expectancies after HIV diagnosisĒ.

They sum up the picture presented by the data: ďAlthough life expectancy and average years of life lost have significantly improved for persons diagnosed from 1996 to 2005 in 25 states, life expectancy remains shorter than for the general population and sex and race/ethnic disparities persist.Ē

Reference
Harrison KM et al.Life expectancy after HIV diagnosis based on national surveillance data from 25 states, United States. J Acquir Immune Defic Syndr, published online ahead of print, 2009. doi: 10.1097/QAI.0b013e3181b563e7.

Other studies seem to indicate differently:

A 25 year-old diagnosed with HIV and treated with HIV therapy can expect to live to his 60s, Danes show

Many patients taking HIV drugs can now expect to live into their 70s

People with HIV and CD4 cell counts over 500 cells/mm3 have same death rate as general population, French study reveals

Bottom line, when it comes to longevity we don't know anything for certain.  We are all individuals with varying experiences, not simple expressions of some average law.  One cannot be too optimistic nor too negative and pessimistic about this subject.   What we do know is that each year modern science is allowing us to extend this quest a bit longer.  For now let's just focus on taking good care of ourselves and LIVING each day in the best possible way.

"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline mecch

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #1 on: September 08, 2009, 03:39:41 PM »
Well its all speculative:  (xyz person in xyz situation "could expect to live until" xyz)

Curious to know, if there are figures for countries with universal health care!!!!!
ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Offline confidentIwillbeOK

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #2 on: September 08, 2009, 06:04:17 PM »
I am a tad confused.  Everything I have read in the past month says the life expectancy for someone living with HIV is now nearing someone without.  I don't have the exact numbers at hand but I thought I had read quite a few studies that found when HAART was available a person's life expectancy is only a few years shorter by being HIV+.  I understand differences in methodologies and calculations across different studies with different population bases but 21 years seems to be drastically different than what I had been reading.  I am going to search for the other articles and re-read this one to see if I can get a handle on why the estimations appear to be so different. 


Offline veritas

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #3 on: September 08, 2009, 06:41:10 PM »

Moon,

"Bottom line, when it comes to longevity we don't know anything for certain.  We are all individuals with varying experiences, not simple expressions of some average law.  One cannot be too optimistic nor too negative and pessimistic about this subject.   What we do know is that each year modern science is allowing us to extend this quest a bit longer.  For now let's just focus on taking good care of ourselves and LIVING each day in the best possible way."

Well said!

v


Offline physicsguy

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #4 on: September 08, 2009, 09:53:11 PM »
Quote
Other studies seem to indicate differently:
Not really.  The first one basically agrees with what you posted, and the third one makes a very specific qualifier - namely that people who are responsible and take care of themselves do not have significantly reduced lifespans.

It should be obvious that, in general, HIV positive people have shorter lifespans, simply because the intersection of people who are HIV positive and people who engage in risky behavior is pretty large compared to the whole group of people who are HIV positive.

Averages are a pretty useless metric in this case.
« Last Edit: September 08, 2009, 09:57:03 PM by physicsguy »

Offline allanq

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #5 on: September 09, 2009, 01:27:50 AM »
According to the article:

One study of over 43,000 patients in 14 cohorts found that whilst a 20 year old starting treatment could expect to live to be 63, this life expectancy was only two-thirds of that in the general population.
---------------

I'm trying to figure out how they determined that a 20-year-old starting treatment could "expect" to live to be 63.

Life expectancy figures are generally based on statistics of actual deaths. It's far too early in this epidemic to determine the average age at death of 20-year-olds starting treatment.

Also, life expectancy for someone with HIV is probably a moving target. The average age at death for 20-year-olds starting treatment in 1988 would probably be lower than for those starting treatment in 2009. These statements about life expectancy do not appear to take into account continuing advances in HIV treatment.

If I'm missing something here, I hope someone will let me know.

Allan

« Last Edit: September 09, 2009, 01:29:23 AM by allanq »
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Offline komnaes

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #6 on: September 09, 2009, 05:39:13 AM »
I always that statistics are only reference to ME if they can be applied to ME.. it may help to guide policies but cruel guesstimates like this one don't affect me personally; the same with the saying that us HIV folks with treatments can expect a "normal lifespan".

I don't know if the research has taken into the fact that "starting" treatment does not necessarily mean treatment coherence, for one thing. And sadly in the US some folks have to struggle for treatments because of financial reasons after they have started; and of course there are always people not taking their meds regularly, etc.

I suppose medically some statistics can be more useful to individual patients, such as certain cancer drugs that can stop it from spreading for a certain duration, and the shorter than duration (definitely not good news for patients, but) better as a predication. IMHO any such duration that is over 10 or even 20 years is too long to be useful to nor, nor will it affect how I see the prospect of my potential lifespan.
Aug 07 Diagnosed
Oct 07 CD4=446(19%) Feb 08 CD4=421(19%)
Jun 08 CD4=325(22%) Jul 08 CD4=301(18%)
Sep 08 CD4=257/VL=75,000 Oct 08 CD4=347(16%)
Dec 08 CD4=270(16%)
Jan 09 CD4=246(13%)/VL=10,000
Feb 09 CD4=233(15%)/VL=13,000
Started meds Sustiva/Epzicom
May 09 CD4=333(24%)/VL=650
Aug 09 CD4=346(24%)/VL=UD
Nov 09 CD4=437(26%)/VL=UD
Feb 10 CD4=471(31%)/VL=UD
June 10 CD4=517 (28%)/VL=UD
Sept 10 CD4=687 (31%)/VL=UD
Jan 11 CD4=557 (30%)/VL=UD
April 11 CD4=569 (32%)/VL=UD
Switched to Epizcom, Reyataz and Norvir
(Interrupted for 2 months with only Epizcom & Reyataz)
July 11 CD=520 (28%)/VL=UD
Oct 11 CD=771 (31%)/VL=UD(<30)
April 12 CD=609 (28%)/VL=UD(<20)
Aug 12 CD=657 (29%)/VL=UD(<20)
Dec 12 CD=532 (31%)/VL=UD(<20)
May 13 CD=567 (31%)/VL=UD(<20)
Jan 14 CD=521 (21%)/VL=UD(<50)

Offline Ann

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #7 on: September 09, 2009, 08:46:45 PM »
Any one of us could get hit by a bus tomorrow.

Shit happens.
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Online Miss Philicia

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #8 on: September 09, 2009, 09:01:59 PM »
*sigh* the bottom line with these studies is that it is only a statistical snapshot considering treatment when the study was done -- hence why these numbers have doubled in the past 10 years.  Why do people here get worked up about these studies when the bottom line is that for every year or so you live, and that HIV treatment improves, so should life expectancy numbers?

It's only "not uplifting" if you fail to look at the issue in the proper context.
« Last Edit: September 09, 2009, 09:04:25 PM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline Rev. Moon

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #9 on: September 09, 2009, 10:31:51 PM »
Any one of us could get hit by a bus tomorrow.

Shit happens.

I actually tend to live by that philosophy.  Well, maybe not a bus, down here public transportation is the pits (and it is so hot that you rarely ever go walking --hence the excess weight on many people, but that is a separate topic that can also kill us).   Car accidents, heart attacks, and all sorts of other crap are however possibilities to always consider.

Why do people here get worked up about these studies when the bottom line is that for every year or so you live, and that HIV treatment improves, so should life expectancy numbers?

It's only "not uplifting" if you fail to look at the issue in the proper context.

Philly, I [personally] don't get very worked up by these sort of news.  For all I know I am one of those who is not really interested in living an excessively long life.  I care more about living whatever time I have left in a good way and/or to the fullest (whatever that may mean).  That's why I had that "bottom line" comment at the end of my initial post ).  I think only veritas noticed it.

When I said it was not "uplifting" I believe I was  thinking of the way that some other members (especially newer ones) might read these sort of studies.  To me context is always important (reason why I am always grateful  for how things are now --even if not ideal-- compared to let's say 15 years ago).  I may be new to having this thing myself, but HIV was around me since I was pretty much a kid.

When it comes down to it anyway, age [and life expectancy] ain't nothing but a number.
« Last Edit: September 10, 2009, 02:10:02 PM by livebythemoon »
"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline tommy246

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #10 on: September 10, 2009, 04:54:37 AM »
This report is an average of the real world taking into account drug addicts,non adherers to meds,people with no access to meds,late diagnoses etc, in my opinion if you live a fairly healthy lifestyle take your meds the reality is you can live the normal life span.
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
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Offline Delby

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #11 on: September 10, 2009, 09:36:31 AM »
To be honest this report has upset me and certainly is contrary to what i've been told by my Dr's. I'm not naive and know this disease is a life limiting disease but, the thing that upsets me the most is i loose all trust and respect for my Dr's. I have seen two of the leading HIV drs in the UK and they both told me - 'oh yes, you'll live a completely normal life span, into your 70's and will die of old age'. They have said it several times with conviction, but this report just shows that they were trying to placate my fears and treat me as you would a child. I wish they would come clean and tell us the truth when we ask. After all its their obligation as a Dr to do so.

Offline tommy246

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #12 on: September 10, 2009, 10:24:11 AM »
Your docs are correct this report is confusing read it again, it takes an average of people including those with no access to meds ,non adherence to meds,drug addicts,and those with very late diagnosis thats why its less years,if you take these factors out of the equation and only included people with healthy lifestyle compliant to there meds then it would be a life span almost if not equal to those non hiv.
Also remember meds are constantly improving ,i dont know your age im 49 and am sure i will be on new meds 5 to 10 years from now ,heck we will probably live longer lol this hiv has got me eating so healthy,back in the gym and off the booze.
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Online Miss Philicia

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #13 on: September 10, 2009, 11:05:36 AM »
To be honest this report has upset me and certainly is contrary to what i've been told by my Dr's. I'm not naive and know this disease is a life limiting disease but, the thing that upsets me the most is i loose all trust and respect for my Dr's. I have seen two of the leading HIV drs in the UK and they both told me - 'oh yes, you'll live a completely normal life span, into your 70's and will die of old age'. They have said it several times with conviction, but this report just shows that they were trying to placate my fears and treat me as you would a child. I wish they would come clean and tell us the truth when we ask. After all its their obligation as a Dr to do so.

Wow.  It's like you've not even read the discussion of all of this in the remainder of the thread. 
"Iíve slept with enough men to know that Iím not gay"

Offline sensual1973

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #14 on: September 10, 2009, 12:12:01 PM »
if am dead am dead
God grant me the serenity to accept the things i can not change.

Online Miss Philicia

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #15 on: September 10, 2009, 12:50:00 PM »
As someone who has personally already gone past his expiration date twice in the past 20 years I really don't fuss with this issue.  I don't have any desire to live past 100 like my grandmother did anyway.
"Iíve slept with enough men to know that Iím not gay"

Offline the trebmeister

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #16 on: September 10, 2009, 02:12:32 PM »
my "use by:" date passed 10 years ago.  i'm too mean to die.
Your friends may say that Iím a stranger
My face theyíll never see no more
There is but one promise thatís given
Iíll sail on Godís golden shore

Offline elf

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #17 on: September 11, 2009, 04:20:01 PM »
HAART has been around for 14 years...
So, some doctors tell you: you will live for 24 years...

When I was diagnosed, the epidemiologist in the HIVtest clinic told me:
''Unfortunately, you're HIV positive
(she crying)
But, you can get treatment.
You can live for 20 years''.

 :-\
My I.D. doc told me I can get a normal lifespan if I'm careful
(taking my meds punctually, eating well, being fit)...

Drug companies cannot guarantee you 30 years or more because,
the drugs have not been around for that long...So, they use the simple formula: 10years+14 (years: 2009-1995) = 24

Also, these are averages, prognosis is better for someone with CD4> 350 on diagnosis
than for someone with CD4 < 5, and better for those without other diseases (like other infections or cancer)...
« Last Edit: September 11, 2009, 04:24:44 PM by elf »
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Offline TheRoof

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #18 on: September 11, 2009, 05:22:03 PM »
To be honest. I am not surprised with this. I am 20 years old, not even old enough to drink and I have this disease.


I thought I'd live to be 80, but I'd be nice if I' can live to 55. But science does improve, and things do change. So far I can see more optimism, because there are discoveries about this year by year.


I can weigh both sides of the situation.

Offline boi2kwik4u

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #19 on: September 12, 2009, 12:58:28 AM »
When I was diagnosed 6 years ago, my HIV doctor said to me "You have a better chance of getting hit by a bus then ever developing AIDS."    and I ferrmally believe that to this day.   Granted my virus has been stable and haven't needs meds yet but I think that's changing this year and I'm ready, no fear.

Offline GNYC09

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #20 on: September 12, 2009, 11:41:12 AM »
don't mean to sound morbid but...although I believe we've got a much longer life expectancy than ever thanks to HAART and the new drugs, I've made sure I only have a few things on my "bucket list" that I need to do before I leave this world.  I expect to have them done within the next few months.  After that, my Maker can swoop me up in his arms if he'd like.  If I live longer, fantastic, it'll all be icing on the cake.  I plan to go out with a big smile on my face.
« Last Edit: September 12, 2009, 11:42:54 AM by GNYC09 »

Offline mewithu

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #21 on: September 12, 2009, 05:44:13 PM »
Personnally I don't want to be 70 years old and have all the problems I amhaving today. But that is just my thougt on this subject.
1997 is when I found out, being deathly ill. I had to go to the hospital due to extreme headache and fever. I fell coma like,  two months later weighing 95 pounds and in extreme pain and awoke to knowledge of Pancreatis, Cryptococcal Meningitis, Thrush,Severe Diarea,  Wasting, PCP pneumonia. No eating, only through tpn. Very sick, I was lucky I had good insurance with the company I worked for. I was in the hospital for three months that time. 
(2010 Now doing OK cd4=210  VL= < 75)
I have become resistant to many nukes and non nukes, Now on Reyataz, , Combivir. Working well for me not too many side effects.  I have the wasting syndrome, Fatigue  . Hard to deal with but believe it or not I have been through worse. Three Pulmonary Embolism's in my life. 2012 520 t's <20 V load

Offline brazilianman

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Re: People with HIV have 21-year reduction in life expectancy in US
« Reply #22 on: September 12, 2009, 06:14:17 PM »
respect all opinions.
but many seem tired of fighting.
life is a gift.
days are ahead.

Bman ;D

 


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