title: Health-adjusted life expectancy in HIV-positive and HIV-negative men and women in British Columbia, Canada: a population-based observational cohort study.
abstract: We sought to understand whether people living with HIV (PLHIV) ever on highly active antiretroviral therapy (ART) follow a pattern where morbidity is compressed into the last years of life or lessened as people age. We aimed to estimate health-adjusted life expectancy (HALE) among adults living with and without HIV, and examine dependency between causes of comorbidities.
  
  
  
  The Comparative Outcomes and Service Utilization Trends (COAST) study is a retrospective cohort of adults (≥20 years) including all known PLHIV and a 10% random sample of the general population of British Columbia, and with longitudinal data spanning from April 1, 1996, to Dec 31, 2012. We determined the prevalence of select comorbidities (cardiovascular, respiratory, liver, and renal diseases, and non-AIDS defining cancers because of their high prevalence among PLHIV) by age and sex by use of case-finding algorithms. Deaths were obtained from a vital event registry from British Columbia, Canada. Comorbid-specific HALE was estimated from 20 years of age by HIV status and sex. For each comorbidity, a healthy state was defined as the proportion of life expectancy comorbid-free, and was adjusted on the probability of occurrence of other different comorbidities. The sensitivity of HALE estimates was assessed to the sequencing of select comorbidities for the dependent comorbidity adjustments.
  
  
  
  Our sample consisted of electronic health records from 9310 HIV-infected and 510 313 uninfected adults over the period April 1, 1996, to Dec 31, 2012. These individuals contributed 49 605 deaths and 5 576 841 person-years over the study period. At exactly age 20 years, HALE was about 31 years (SD 0·16) among men living with HIV and 27 years (0·16) among women living with HIV. In the HIV-negative population, HALE was around 58 years (SD 0·02) for men and 63 years (0·02) for women. These results seem independent of ordering. However, PLHIV, particularly women living with HIV, had much shorter overall life expectancies than did their HIV-negative counterparts in the general population [29·1 years (SD 0·1) vs 65·4 years (0·1)], and thus spent less time in a healthy state.
  
  
  
  Although we noted little differences in the levels of morbidity compression by HIV status, PLHIV-especially women living with HIV-spent less time in a healthy state. Expanded service delivery interventions to address complex care needs of ageing PLHIV are crucial to address shorter life expectancies, and improve their healthy states.
  
  
  
  Canadian Institutes of Health Research.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Electronic address: rhogg@sfu.ca.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Oghenowede
authors.initials: O
authors.lastname: Eyawo
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Collins
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Zhang
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Shahab
authors.initials: S
authors.lastname: Jabbari
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Hull
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada.
authors.forename: Viviane Dias
authors.initials: VD
authors.lastname: Lima
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Tareq
authors.initials: T
authors.lastname: Ahmed
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada; Department of Family Medicine, University of Ottawa, ON, Canada.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Kendall
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Keri N
authors.initials: KN
authors.lastname: Althoff
authors.affiliation: VA Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, New Haven, CT, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada.
authors.forename: Rolando
authors.initials: R
authors.lastname: Barrios
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, BC, Canada.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Shoveller
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada.
authors.forename: Julio S G
authors.initials: JSG
authors.lastname: Montaner
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult