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HIV Infection, When Well Treated, May Not Increase Risk Of Death

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Published: Aug 10, 2011 2:54 pm
HIV Infection, When Well Treated, May Not Increase Risk Of Death

Results from a recent Danish study indicate that HIV, when treated optimally with antiretrovirals, may not increase a person’s risk of death compared to the general population.

Instead, the authors found that HIV-positive individuals suffer from higher death rates mainly due to HIV and non-HIV-related risk factors such as poor response to antiretroviral therapy, co-infection with hepatitis C or other diseases, and drug and alcohol abuse.

“In general, HIV-infected patients without co-morbidity or abuse and who receive antiretroviral therapy successfully, are almost at the same risk of death as the non-HIV-infected population,” said Dr. Lars Omland, lead author of the study, in correspondence with The AIDS Beacon.

“These findings somewhat contradict the concept of accelerated aging in HIV-infected patients, and in combination with the supporting literature, should reassure HIV-infected patients that they have a normal life-expectancy,” he added.

The authors suggested that early diagnosis, timely and effective initiation of antiretroviral therapy, and the treatment of other illnesses and alcohol and drug abuse are important in the management of HIV infection.

The advent of antiretroviral therapy has improved the quality of life for people with HIV and diminished the risk of death.

However, according to the study authors, the death rate for people with HIV is still significantly higher than that of the general population. The cause of this higher death rate, and whether it is due to HIV infection itself (including side effects of antiretroviral therapy), lifestyle factors such as smoking and drug abuse, or the presence of other illnesses has remained unclear.

In this study, researchers investigated the impact of HIV-related risk factors and non-HIV-related risk factors on the death rate of HIV-positive adults versus the general population in Denmark.

The study included 2,267 HIV-positive adults, aged 25 to 65 years, who started antiretroviral therapy between January 1998 and July 2009 and had taken antiretrovirals for at least a year. The study also included 9,068 HIV-negative individuals with no risk factors who were matched based on age and gender.

The authors categorized all HIV-positive participants based on HIV-related risk factors such as detectable viral load (amount of HIV in the blood greater than 49 copies per milliliter), CD4 (white blood cell) counts below 200 cells per microliter of blood, or AIDS-defining diseases; and non-HIV-related risk factors such as co-infection with hepatitis C, presence of other illnesses, and alcohol and drug abuse.

Results showed that, consistent with previous studies, the HIV-positive population had an increased death rate compared to the HIV-negative population. People with HIV aged 25 to 45 years old were 8.6 times more likely to die than people without HIV of the same age and gender, and HIV-positive adults aged 45 to 65 years old were 6 times more likely to die than age- and gender-matched adults without HIV.

However, for individuals between the ages of 45 and 65, HIV-positive patients with no identifiable risk factors had death rates equivalent to those of the general population. For the 25 to 45 age group, people with HIV but no other risk factors had a death rate twice that of people without HIV.

The researchers calculated that the probability of surviving to age 65 was 86 percent for people with HIV and no risk factors, versus 88 percent for people without HIV.

However, both HIV-related and non-HIV-related risk factors significantly increased the risk of death in people with HIV. Compared to the HIV-negative population, the researchers found a more than four-fold increased risk of death in HIV patients with HIV-related risk factors and a 20-fold increased risk of death in people with HIV who had alcohol or drug abuse problems.

For more information, please see the study in PLoS One.

Photo by Wesley Carter of the U.S. Air Force on Wikipedia - this image is in the public domain.
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