title: Projected life expectancy of people with HIV according to timing of diagnosis.
abstract: OBJECTIVE
  Effective antiretroviral therapy (ART) has contributed greatly toward survival for people with HIV, yet many remain undiagnosed until very late. Our aims were to estimate the life expectancy of an HIV-infected MSM living in a developed country with extensive access to ART and healthcare, and to assess the effect of late diagnosis on life expectancy.
  
  
  METHODS
  A stochastic computer simulation model of HIV infection and the effect of ART was used to estimate life expectancy and determine the distribution of potential lifetime outcomes of an MSM, aged 30 years, who becomes HIV positive in 2010. The effect of altering the diagnosis rate was investigated.
  
  
  RESULTS
  Assuming a high rate of HIV diagnosis (median CD4 cell count at diagnosis, 432  cells/μl), projected median age at death (life expectancy) was 75.0 years. This implies 7.0 years of life were lost on average due to HIV. Cumulative risks of death by 5 and 10 years after infection were 2.3 and 5.2%, respectively. The 95% uncertainty bound for life expectancy was (68.0,77.3) years. When a low diagnosis rate was assumed (diagnosis only when symptomatic, median CD4 cell count 140  cells/μl), life expectancy was 71.5 years, implying an average 10.5 years of life lost due to HIV.
  
  
  CONCLUSIONS
  If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals. The greatest risk of excess mortality is due to delays in HIV diagnosis.
authors.affiliation: HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, UK. f.nakagawa@ucl.ac.uk
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Nakagawa
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Lodwick
authors.forename: Colette J
authors.initials: CJ
authors.lastname: Smith
authors.forename: Ruth
authors.initials: R
authors.lastname: Smith
authors.forename: Valentina
authors.initials: V
authors.lastname: Cambiano
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003198:Computer Simulation; D057210:Delayed Diagnosis / Q000009:adverse effects; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D018451:Homosexuality, Male; D006801:Humans; D008017:Life Expectancy; D008297:Male; D017410:Practice Guidelines as Topic; D015996:Survival Rate; D013997:Time Factors; D006113:United Kingdom
chemical_list: D019380:Anti-HIV Agents