Combination ART offers near-normal lifespan - study

HIV-positive Africans on combination antiretroviral therapy (ART) can hope to live almost as long as their HIV-negative peers, according to a new study by Canada's British Columbia Centre for Excellence in HIV/AIDS.



The study, published in the Annals of Medicine, of 22,315 HIV-positive patients of the large Ugandan NGO, The AIDS Support Organization, between 2000 and 2009, found that patients put on combination therapy at age 20 lived an additional 26.7 years, and at age 35 another 27.9 years.



The average life expectancy in Uganda is 55. The authors believe the Ugandan situation is replicated across many African countries where large-scale combination ART is being rolled out.



This is the first study that shows the impact of combination treatment on life expectancy in sub-Saharan Africa - where more than a third of the 10 million HIV-positive people needing treatment are receiving it.



"The Ugandan study validates what we have known about combination ART and life expectancy in the West for many years - that HIV-positive people can have a relatively normal lifespan," Nathan Ford, medical coordinator for Médecins Sans Frontières' Access to Essential Medicines campaign, co-author of the study, told IRIN/PlusNews at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.



A 2009 study of life expectancy of people on combination ART in high-income countries found that the average life expectancy at age 20 was about two-thirds that of the general population.



"In the pre-ART era, people died within months of diagnosis, and in the early 1990s - when people took monotherapy, dual therapy or were only able to access treatment for a short while during clinical trials - it was really about buying a few more months," said Ford.



"Patients agreed to the treatment in order to buy a couple of years to arrange their affairs, whether it was to put their kids in school or ensure their families were cared for.



"Today, many of those patients are still alive, thanks to combination treatment... in Khayelitsha [township in Cape Town, South Africa], 10 years down the line, we now have 20,000 people on ART," he added.



Early initiation, sustained investment



The study found significant differences in life expectancy based on CD4 count - a measure of immune strength - at initiation of ART. "Low CD4 cell count status at baseline was strongly predictive of lower life expectancy, a finding supportive of the latest WHO [UN World Health Organization] recommendation to start treatment at higher CD4 cell counts," the authors reported. "Unfortunately, accessing and treating patients at early stages can be a challenge for both health infrastructure and identifying patients."



In addition, men were found to access care at a later stage when the disease was more advanced and had higher rates of mortality and loss to follow-up than women; life expectancy at age 20 was another 19.1 years for males, compared with 30.6 years for females.



The authors note that the study is evidence that the global investment in HIV is having the desired results, and should encourage donors to invest further in HIV treatment in poor nations. In Uganda, for instance, only half the 400,000 patients thought to need ART are receiving it.



"These benefits will only be sustained if there is continued support for combination ART scale-up by the international donor community and national governments," said study author Jean Nachega, professor of medicine at South Africa's Stellenbosch University, in a statement. "We require sustainable investment and simplified treatment options to deliver long-term care and access more people in Africa with HIV."



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