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Life expectancy in HIV-positive persons in Switzerland: matched comparison with general population
Aysel Gueler1, André Moser, Alexandra Calmy
1aInstitute of Social and Preventive Medicine (ISPM) bDepartment of Geriatrics, Inselspital, Bern University Hospital, University of Bern cDivision of Infectious Diseases, University of Geneva, Geneva dDivision of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich eInstitute of Medical Virology, University of Zurich, Zurich fDivision of Infectious Diseases, Regional Hospital Lugano, Lugano gDepartment of Infectious Diseases, Bern University Hospital, and University of Bern hDivision of Infectious Diseases, Cantonal Hospital Aarau, Aarau iDivision of Infectious Diseases & Hospital Epidemiology, University of Basel, Basel jDivision of Infectious Diseases, Department of Medicine, University Hospital of Lausanne, University of Lausanne, Lausanne kDivision of Infectious Diseases, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland lCentre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, South Africa.
Objectives:
To estimate life expectancy over 25 years in HIV-positive people and to compare their life expectancy with recent estimates for the general population, by education.
Methods:
Patients aged 20 years or older enrolled in the Swiss HIV Cohort Study 1988-2013 were eligible. Patients alive in 2001 were matched to up to 100 Swiss residents, by sex, year of birth, and education. Life expectancy at age 20 was estimated for monotherapy (1988-1991), dual therapy (1992-1995), early combination antiretroviral therapy (cART, 1996-1998), later cART (1999-2005) and recent cART (2006-2013) eras. Parametric survival regression was used to model life expectancy.
Results:
In all, 16 532 HIV-positive patients and 927 583 residents were included. Life expectancy at age 20 of HIV-positive individuals increased from 11.8 years [95% confidence interval (CI) 11.2-12.5] in the monotherapy era to 54.9 years (95% CI 51.2-59.6) in the most recent cART era. Differences in life expectancy across educational levels emerged with cART. In the most recent cART period, life expectancy at age 20 years was 52.7 years (95% CI 46.4-60.1) with compulsory education, compared to 60.0 years (95% CI 53.4-67.8) with higher education. Estimates for the general population were 61.5 and 65.6 years, respectively. Male sex, smoking, injection drug use, and low CD4 cell counts at enrolment were also independently associated with mortality.
Conclusion:
In Switzerland, educational inequalities in life expectancy were larger among HIV-infected persons than in the general population. Highly educated HIV-positive people have an estimated life expectancy similar to Swiss residents with compulsory education. Earlier start of cART and effective smoking-cessation programs could improve HIV-positive life expectancy further and reduce inequalities.
