Treatment for HIV, or antiretroviral therapy, consists of the combination of at least three antiretroviral drugs that suppress the virus and stop the progression of HIV. A treatment regimen can be started at any point after diagnosis – though the sooner, the better – and is recommended for all people living with HIV.

While antiretroviral therapy has dramatically improved life expectancy for those living with HIV, especially when initiated early in the course of the infection, Julia Marcus, PhD and colleague Michael Silverberg, PhD from Kaiser Permanente saw a lack of recent data comparing lifespan between people with HIV and people without HIV. There were also few studies that had examined how many of those years were healthy, or free of major chronic comorbidities.

Their new study, published in JAMA Network Open, sought to fill in this knowledge gap by examining overall life expectancy and comorbidity-free years in a large cohort of people with HIV and demographically similar uninfected adults from Kaiser Permanente in Northern and Southern California, and Kaiser Permanente Mid-Atlantic States during 2000-2016. The team focused on six chronic comorbidities: chronic liver disease, chronic kidney disease, chronic lung disease, diabetes, cancer, and cardiovascular disease.

Study Results

The study team found that people with HIV who initiated antiretroviral therapy early in the course of infection, with high CD4 counts, lived 6.8 fewer years than people without HIV, and 9.5 fewer years without major chronic comorbidities. These findings suggest that people who initiate antiretroviral therapy at high CD4 counts are approaching the same lifespan as people without HIV, but that greater attention is needed to prevention of comorbidities among people with HIV.

In the era of COVID-19, which has been shown to disproportionately affect those living with comorbidities, the need for comorbidity prevention among people with HIV is even more important. We talked to lead author Julia Marcus about the implications of living with HIV during the pandemic.

Q: From what we know to date, individuals with a chronic comorbidity, including several of those your team examined in this study, may face higher risk of severe illness from COVID-19. The results of your study show that even though the gap in comorbidity-free life expectancy has narrowed over the years, people with HIV are still prone to developing chronic conditions earlier than those without HIV. What are the implications of these findings in the COVID-19 era?

A: The current evidence on COVID-19 suggests that some chronic comorbidities are associated with an increased risk of severe illness. We found that several of these conditions – including chronic lung disease, chronic liver disease, and diabetes – are more common and develop at younger ages among people with HIV compared with their HIV-negative counterparts. Although there is no evidence that HIV infection itself is a risk factor for severe COVID-19, there have been only a few small studies to date, and some people with HIV may be at increased risk because of other chronic comorbidities.

Q: You’ve written recently about a harm reduction approach to disease prevention, acknowledging that an “abstinence only” approach to life during COVID-19 is not sustainable in the long term. You’ve suggested various ways that the public can weigh risks and benefits as they ease back into everyday life. What might your guidance look like for people with HIV, including those with comorbidities? 

 A: Anyone who might be particularly vulnerable to COVID-19, because of either older age or a chronic condition, will need to take that vulnerability into consideration when weighing the risks and benefits of interacting with people outside of their household. The same is true for people with HIV who have underlying conditions that are associated with increased risk of severe illness from COVID-19. The current understanding is that people with HIV who are on antiretroviral therapy are not at increased risk of severe illness from COVID-19, but people with poorly controlled HIV or AIDS may need to be more cautious.

Q: What are some resources for people with HIV to remain up-to-date on the latest COVID-19 recommendations and guidelines?

A: The CDC has an FAQ on what people need to know about HIV and COVID-19.

Q: What future studies are you and your team considering to expand on this work?

Our next step is to look at other comorbidities that we didn’t include in this study, including dementia, which is becoming more of a concern as the population of people with HIV ages. We’re also interested in exploring outcomes of COVID-19 in people with and without HIV infection.

Follow Dr. Marcus on Twitter @JuliaLMarcus | Watch Dr. Marcus discuss study results on Medpage Today

Co-authors on the study include Wendy A. Leyden, MPH, Stacey Alexeeff, PhD, Alexandra Anderson, MPH, Jennifer O. Lam, PhD, Division of Research, Kaiser Permanente Northern California; Rulin Hechter, PhD, William J. Towner, MD, Qing Yuan, MPH, Division of Research and Evaluation, Kaiser Permanente Southern California; Haihong Hu, MPH, Michael A. Horberg, MD, Mid-Atlantic Permanente Research Institute.

Marcus JL, Leyden WA, Alexeeff SE, et al. Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016. JAMA Netw Open. 2020;3(6):e207954. doi:10.1001/jamanetworkopen.2020.7954