A large study of 88,504 people with HIV on antiretroviral therapy (ART), published in the Lancet journal and reported widely in the news, has found substantial improvements in life expectancy in people with HIV who started ART after 2008, even in their first year of therapy. People who started ART in 2008-2010 and who had achieved CD4 counts over 350 cells/mm3 by the end of their first year of therapy had life expectancies approaching normal.
The researchers point out that this study only looks at mortality in people taking ART – “whereas most deaths in people with HIV infection occur in the untreated population.” They also comment that the life-expectancy benefits of ART “are not shared by all…Specifically, individuals who… have a history of injection drug use, or began ART with low CD4 cell counts have no reduction in mortality or improvements in life expectancy,” they say. They add that the uneven benefits of ART are not merely due to socioeconomic disadvantage or the effects of stigma but also to outdated perceptions of HIV treatment. “The previous era of inferior drugs and poor outcomes for patients has left a legacy that will be difficult to overcome,” they say. “Fear of medication-related side-effects is a leading psychosocial barrier to treatment initiation and has led to concerns that ART might actually make a patient sick. Interventions to increase awareness of the many positive benefits of early ART initiation and to allay fears of drug toxicity are needed, especially in individuals who feel healthy and might perceive ART as more of an immediate risk than a benefit,” they add.
The full article can be read here.