title: Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care.
abstract: It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care.
  
  
  
  We conducted a cohort study within Kaiser Permanente California during 1996-2011, using abridged life tables to estimate the expected years of life remaining ("life expectancy") at age 20.
  
  
  
  Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996-1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9-14.8 years) in 2011. In 2008-2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008-2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1-10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors.
  
  
  
  Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.
authors.affiliation: *Division of Research, Kaiser Permanente Northern California, Oakland, CA; †Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA; ‡Kaiser Permanente San Leandro Medical Center, Kaiser Permanente Northern California, San Leandro, CA; §Department of Research and Evaluation, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; and ‖Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic, Rockville, MD.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Marcus
authors.forename: Chun R
authors.initials: CR
authors.lastname: Chao
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Leyden
authors.forename: Lanfang
authors.initials: L
authors.lastname: Xu
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Klein
authors.forename: William J
authors.initials: WJ
authors.lastname: Towner
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology*; D006297:Health Services Accessibility; D006801:Humans; D008017:Life Expectancy; D008297:Male