S

Temporal Changes in Life Expectancy in HIV-positive individuals in North America

CROI – March 8, 2012

Robert Hogg, Hasina Samji, Angela Cescon, Sharada Modur, Sonia Napravnik, Jeffrey Martin, John Gill, Marina Klein,

Gregory Kirk, Stephen Gange, for the North American AIDS Cohort Collaboration on Research and Design (NA-

ACCORD) of IeDEA

Background

HAART is known to decrease morbidity and mortality among HIV-positive people and reduce transmission.

ART-CC has shown that life expectancy at age 20 years increased from 36 to 49 years from 1996-99 to 2003-05.

Women have higher life expectancy than men.

In North America, life expectancy of HIV-positive people on HAART is not well characterized.

Objective

Estimate temporal changes in life expectancy from 1996-2007 in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

NA-ACCORD

Large, representative collaboration of 23 clinical and interval cohort studies in the United States and Canada.

Study sample

HIV-positive people in NA-ACCORD were included in this analysis if they were aged 20 years or over and antiretroviral-naive when initiating HAART.

18 cohorts contributed data to this analysis.

Person-time and deaths

Deaths ascertained through linkage and reports.

Deaths and person-time partitioned into five-year age categories and by calendar period.

Follow-up further partitioned by sex, race, HIV transmission group, and baseline CD4.

Abridged life tables

Abridged life tables were constructed from person-years and deaths partitioned by five year age groups starting at age 20 years.

Standard errors were calculated for each corresponding life expectancy estimate.

Overall sample selection

NA-ACCORD N=75,148 (100%)

Eligible cohorts N=73,876 (98.3%)

On HAART N=37,214 (49.5%)

First starts on HAART N=27,268 (36.2%)

Last active N=23,730 (31.6%)

Deaths and person-years

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

0

5000

10000

15000

20000

25000

Person-years (n=89,521)Deaths (n = 1,799)

Age-specific death rates, 1996-2007

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+0

10

20

30

40

50

60

70

1996-992000-022003-052006-07

Rat

es p

er 1

000

Temporal changes in life expectancy,1996-2007

1996-99 2000-02 2003-05 2006-0705

101520253035404550

34.436.9

43.147.1

Life expectancy at age 20 years

Life expectancy by sex, 1996-2007

Source: WHO – Canadian and US Life tables for year 2000

Canada US NA ACCORD0

10

20

30

40

50

60

70

57.5 55.3

41.3

62.6 60.4

42.7

MalesFemales

Life expectancy at age 20 years

Life expectancy by race, 1996-2007

White African American Hispanic0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.059.0

54.761.4

50.0

41.0

52.6

USNA ACCORD

Source: CDC Vital and health statistics, US Life tables by race for 2006

Life expectancy at age 20 years

Life expectancy by transmission group (1996-2007)

IDU MSM Heterosexual0

10

20

30

40

50

60

28.1

51.647.7

Life expectancy at age 20 years

Life expectancy by CD4 category (1996-2007)

<100 100-199 200-349 350-499 500+0

10

20

30

40

50

60

29.0

44.2

52.4 52.646.4

Life expectancy at age 20 years

Loss to follow-up

Pooled logistic regression models used to obtain period-specific inverse probability of censoring weights yielded the following results:

Overall median of the weights was 0.998 (IQR=0.974-1.026).

Weighted Poisson models for mortality rates yielded similar results to the crude analysis.

Adjusting for loss-to-follow-up censoring led to similar mortality rates as in the crude analysis

Limitations

Loss to follow-up.

Under-ascertainment of mortality.

Differences in mortality may be accounted for due to variables that were not included in this analysis.

Limits with the life table methodology due to small numbers.

Conclusions

Life expectancy among those on HAART increasing over time.

Differences by transmission group, race, and CD4 cell count.

The US National AIDS and Canadian AIDS strategies must continue to address the striking disparities in life expectancies.

AcknowledgmentsNA-ACCORD participating cohorts:

AIDS Link to the IntraVenous Experience (ALIVE; Gregory Kirk)

Adult AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT; Constance Benson, Ron Bosch, Ann Collier)

Fenway Community Health Center (Stephen Boswell, Chris Grasso)

HIV Research Network (HIVRN; Kelly Gebo)

HAART Observational Medical Evaluation and Research (HOMER; Robert Hogg, Angela Cescon, Richard Harrigan, Julio Montaner, Hasina Samji)

HIV Outpatient Study (HOPS; John T. Brooks, Kate Buchacz)

Johns Hopkins HIV Clinical Cohort (JHHCC; Richard Moore)

John T. Carey Special Immunology Unit Patient Care and Research Database, Case Western Reserve University (Benigno Rodriguez)

Kaiser Permanente Northern California (KPNC; Michael Horberg, Michael Silverberg)

Longitudinal Study of Ocular Complications of AIDS (LSOCA; Jennifer Thorne)

Multicenter AIDS Cohort Study (MACS; Lisa Jacobson)

Multicenter Hemophilia Cohort Study–II (MHCS-II; James Goedert, Eric Engels )

Montreal Chest Institute Immunodeficiency Service Cohort (Marina Klein)

Ontario HIV Treatment Network Cohort Study (OHTN; Sean Rourke, Anita Rachlis)

Retrovirus Research Center (RRC; Robert F Hunter-Mellado, Angel Mayor)

Southern Alberta Clinic Cohort (SAC; M. John Gill)

Studies of the Consequences of the Protease Inhibitor Era (SCOPE; Steven Deeks, Jeff Martin)

The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN; Pragna Patel)

University of Alabama at Birmingham Clinic Cohort (Michael Saag, James Willig)

University of North Carolina, Chapel Hill HIV Clinic Cohort (UCHCC; Joseph Eron, Sonia Napravnik)

University of Washington HIV Cohort (Mari Kitahata, Heidi Crane)

Veterans Aging Cohort Study (VACS; Amy Justice, Robert Dubrow)

Vanderbilt-Meharry CFAR Cohort (Timothy Sterling)

Women’s Interagency HIV Study (WIHS; Kathryn Anastos, Stephen Gange, Nancy Hessol, Howard Strickler)

Support: National Institute of Allergy & Infectious Diseases, with supplemental funding from the National Cancer Institute.

Executive Committee: Richard Moore, Michael Saag, Stephen Gange, Mari Kitahata, Rosemary McKaig (NIH), Amy Justice, Aimee Freeman

Epidemiology/Biostatistics Core: Stephen Gange (Chair), Alison Abraham, Keri Altoff, Elizabeth Golub, David Hanna, Yuezhou Jing, Bryan Lau, Adell Mendes, Shareda Modur, Peter Rebeiro, Jinbing Zhang

Data Management Core: Mari Kitahata (Chair), Chad Achenbach, Liz Morton, Stephen Van Rompaey, Eric Webster

Administrative Core: Richard Moore (Chair), Aimee Freeman, Carol Lent, Aaron Platt