People with HIV are living around a decade longer than they did 20 years ago, according to a new report.
Doctors and charities called the increase in life expectancy for people with the virus in Europe and the US a “tremendous medical achievement” – but warned many are missing out on life-saving drugs as they have not yet been diagnosed as HIV positive.
The research paper, published in The Lancet HIV, said improvements in medical care meant a European 20-year-old who began treatment in 2008 could now expect to live to nearly 70 years old.
While this is below the average life expectancy of around 80 in the UK, the study’s authors said they hoped their findings would “decrease stigmatisation of people living with HIV and help them to obtain insurance or employment”.
Developments in antiretroviral therapy (ART), daily drugs that slow the progress of HIV infection first introduced in the mid-1990s, have helped to improve survival rates.
“Combination antiretroviral therapy has been used to treat HIV for 20 years, but newer drugs have fewer side effects, involve taking fewer pills, better prevent replication of the virus and are more difficult for the virus to become resistant to,” said lead author Adam Trickey, of the University of Bristol.
However, as the drugs used to treat the condition are already highly safe and effective, other approaches, such as improved diagnosis of non-AIDS related diseases, will be necessary to help people with HIV live as long as the general population in future, wrote the researchers.
“Information about life expectancy in people living with HIV and the knowledge that it could be approaching that of the general population is important to motivate at-risk individuals to test for HIV and convince those infected to start ART immediately,” they said.
The research used data from 88,504 people taking treatment for HIV between 1996 and 2010 from 18 different studies undertaken in Europe and North America.
In both locations, life expectancy for 20-year-olds treated for HIV was found to increase by nine years for women and 10 years for men.
In Europe, HIV-positive men and women can now expect to reach their 67th birthday, while in the US, life expectancy was at 66 for men and 63 for women with HIV.
These improvements were not seen for all people with HIV, however, with life expectancy of intravenous drug users not increasing as much as other groups.
Dr Michael Brady, medical director at charity the Terrence Higgins Trust, said the report “reminds us just how far we’ve come since the start of the HIV epidemic in the 1980s.”
“This is great news. However, it also means we’re entering uncharted territory. People aged over 50 now represent one in three of all those living with HIV,” he said.
“As it stands, the healthcare, social care and welfare systems simply aren’t ready to support the increasing numbers of people growing older with HIV.
“We need a new model of care to better integrate primary care with HIV specialist services, and we need a major shift in awareness and training around HIV and ageing, so that we’re ready to help older people live well in later life.”
Professor Helen Stokes-Lampard, chair of the Royal College of GPs, added: “It’s a tremendous medical achievement that an infection that once had such a terrible prognosis is now so manageable, and that patients with HIV are living significantly longer.”
Both Dr Brady and Professor Stokes-Lampard pointed out that one in seven people with HIV are unaware they have the virus and emphasised the importance of increased testing.
The acting director of the European Centre for Disease Prevention and Control (ECDC) has estimated 120,000 of people in EU countries are unaware they have with HIV.
“The fact that life expectancy for patients with HIV has risen so significantly is testament to the success of antiretroviral therapy since it’s introduction. But continued success is dependent on people knowing they have HIV, so that they can start treatment,” said Professor Stokes-Lampard.
“It is important that we work together and take steps to increase appropriate HIV testing in primary care – this has been made clear in recent NICE guidelines,” she said, adding: “We are working to develop resources to support GPs and our teams to do this”.
Dr Tristan Barber, chair of the HIV special interest group at the British Association for Sexual Health and HIV (BASHH), said: “'BASHH welcomes these findings which reinforce the importance of specialist HIV care and testing strategies, and the benefits of delivering earlier diagnosis and treatment.
“This success story means people infected with HIV can look forward to a near normal life expectancy which is to be to be celebrated, but whilst doing so we must also continue to look at ways to prevent infection, including rolling out pre exposure prophylaxis (PrEP) more widely to those at risk, as well as funding research to find ways to eradicate the virus from those who already have it.”
The Liberal Democrats have said if they are elected, they will make PrEP, a once-a-day pill that reduces the risk of HIV infection, available on the NHS.
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