title: Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy.
abstract: OBJECTIVE
  The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART).
  
  
  METHODS
  Patients aged more than 20 years who started ART during 2000-2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012. We determined the latest CD4 cell count and viral load before ART and in each of years 1-5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4 cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20-85 years.
  
  
  RESULTS
  Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 person-years. At start of ART, expected age at death [95% confidence interval (CI)] of 35-year-old men with CD4 cell count less than 200, 200-349, at least 350 cells/μl was 71 (68-73), 78 (74-82) and 77 (72-81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five-year-old men who increased their CD4 cell count in the first year of ART from less than 200 to 200-349 or at least 350 cells/μl and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48-61) (CD4 cell count <200 cells/μl and no viral suppression) to 80 (76-83) years (CD4 cell count ≥350 cells/μl and viral suppression).
  
  
  CONCLUSIONS
  Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4 cell count significantly improve their life expectancy if they have a good CD4 cell count response and undetectable viral load.
authors.affiliation: aUniversity of Bristol bNorth Bristol NHS Trust, Bristol cPublic Health England dMedical Research Council Clinical Trials Unit eBarts and The London NHS Trust fSouth London Healthcare NHS Trust gSt George's Healthcare NHS Trust hRoyal Free Hampstead NHS Trust, London iUniversity Hospitals of Leicester NHS Trust, Leicester jMortimer Market Centre, University College Medical School, London kSouth Tees Hospital NHS Foundation Trust, Middlesbrough lYork Teaching Hospital NHS Foundation Trust, York mResearch Department of Infection & Population Health, UCL nImperial College Healthcare NHS Foundation Trust oKings College Healthcare NHS Foundation Trust and Kings College London, London pBrighton and Sussex University Hospitals NHS Trust, Brighton qNorth Middlesex University Hospital NHS Trust, London rThe Lothian University Hospitals NHS Trust, Edinburgh sChelsea and Westminster NHS Foundation Trust tHomerton University Hospital NHS Trust, London, UK.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: May
authors.forename: Mark
authors.initials: M
authors.lastname: Gompels
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
authors.forename: Chloe
authors.initials: C
authors.lastname: Orkin
authors.forename: Stephen
authors.initials: S
authors.lastname: Kegg
authors.forename: Phillip
authors.initials: P
authors.lastname: Hay
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Adrian
authors.initials: A
authors.lastname: Palfreeman
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
authors.forename: David
authors.initials: D
authors.lastname: Chadwick
authors.forename: Fabiola
authors.initials: F
authors.lastname: Martin
authors.forename: Teresa
authors.initials: T
authors.lastname: Hill
authors.forename: John
authors.initials: J
authors.lastname: Walsh
authors.forename: Frank
authors.initials: F
authors.lastname: Post
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ainsworth
authors.forename: Sophie
authors.initials: S
authors.lastname: Jose
authors.forename: Clifford
authors.initials: C
authors.lastname: Leen
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents