BACKGROUND: Most persons with human immunodeficiency virus (HIV) infection in the United States present to care with advanced disease, and many patients discontinue therapy prematurely. We sought to evaluate sex and racial/ethnic disparities in life-years lost as a result of risk behavior, late presentation, and early discontinuation of HIV care, and we compared these survival losses for HIV-infected persons with losses attributable to high-risk behavior and HIV disease itself. METHODS: With use of a state-transition model of HIV disease, we simulated cohorts of HIV-infected persons and compared them with uninfected individuals who had similar demographic characteristics. We estimated non-HIV-related mortality with use of risk-adjusted standardized mortality ratios, as well as years of life lost because of late presentation and early discontinuation of antiretroviral therapy (ART) for HIV infection. Data from the national HIV Research Network, stratified by sex and race/ethnicity, were used for estimating CD4+ cell counts at ART initiation. RESULTS: For HIV-uninfected persons in the United States who have risk profiles similar to those of individuals with HIV infection, the projected life expectancy, starting at 33 years of age, was 34.58 years, compared with 42.91 years for the general US population. Those with HIV infection lost an additional 11.92 years of life if they received HIV care concordant with guidelines; late treatment initiation resulted in 2.60 additional years of life lost, whereas premature ART discontinuation led to 0.70 more years of life lost. Losses from late initiation and early discontinuation were greatest for Hispanic individuals (3.90 years). CONCLUSIONS: The high-risk profile of HIV-infected persons, HIV infection itself, as well as late initiation and early discontinuation of care, all lead to substantial decreases in life expectancy. Survival disparities resulting from late initiation and early discontinuation of therapy are most pronounced for Hispanic HIV-infected men and women. Interventions focused on risk behaviors, as well as on earlier linkage to and better retention in care, will lead to improved survival for HIV-infected persons in the United States.
BACKGROUND: Most persons with humanimmunodeficiency virus (HIV) infection in the United States present to care with advanced disease, and many patients discontinue therapy prematurely. We sought to evaluate sex and racial/ethnic disparities in life-years lost as a result of risk behavior, late presentation, and early discontinuation of HIV care, and we compared these survival losses for HIV-infectedpersons with losses attributable to high-risk behavior and HIV disease itself. METHODS: With use of a state-transition model of HIV disease, we simulated cohorts of HIV-infectedpersons and compared them with uninfected individuals who had similar demographic characteristics. We estimated non-HIV-related mortality with use of risk-adjusted standardized mortality ratios, as well as years of life lost because of late presentation and early discontinuation of antiretroviral therapy (ART) for HIV infection. Data from the national HIV Research Network, stratified by sex and race/ethnicity, were used for estimating CD4+ cell counts at ART initiation. RESULTS: For HIV-uninfectedpersons in the United States who have risk profiles similar to those of individuals with HIV infection, the projected life expectancy, starting at 33 years of age, was 34.58 years, compared with 42.91 years for the general US population. Those with HIV infection lost an additional 11.92 years of life if they received HIV care concordant with guidelines; late treatment initiation resulted in 2.60 additional years of life lost, whereas premature ART discontinuation led to 0.70 more years of life lost. Losses from late initiation and early discontinuation were greatest for Hispanic individuals (3.90 years). CONCLUSIONS: The high-risk profile of HIV-infectedpersons, HIV infection itself, as well as late initiation and early discontinuation of care, all lead to substantial decreases in life expectancy. Survival disparities resulting from late initiation and early discontinuation of therapy are most pronounced for Hispanic HIV-infectedmen and women. Interventions focused on risk behaviors, as well as on earlier linkage to and better retention in care, will lead to improved survival for HIV-infectedpersons in the United States.
Authors: K A Freedberg; E Losina; M C Weinstein; A D Paltiel; C J Cohen; G R Seage; D E Craven; H Zhang; A D Kimmel; S J Goldie Journal: N Engl J Med Date: 2001-03-15 Impact factor: 91.245
Authors: W E Cunningham; L E Markson; R M Andersen; S H Crystal; J A Fleishman; C Golin; A Gifford; H H Liu; T T Nakazono; S Morton; S A Bozzette; M F Shapiro; N S Wenger Journal: J Acquir Immune Defic Syndr Date: 2000-10-01 Impact factor: 3.731
Authors: Kelly A Gebo; John A Fleishman; Richard Conviser; Erin D Reilly; P Todd Korthuis; Richard D Moore; James Hellinger; Philip Keiser; Haya R Rubin; Lawrence Crane; Fred J Hellinger; W Christopher Mathews Journal: J Acquir Immune Defic Syndr Date: 2005-01-01 Impact factor: 3.731
Authors: Matthew Hickman; Zenobia Carnwath; Peter Madden; Michael Farrell; Cleone Rooney; Richard Ashcroft; Ali Judd; Gerry Stimson Journal: J Urban Health Date: 2003-06 Impact factor: 3.671
Authors: Mardge H Cohen; Judith A Cook; Dennis Grey; Mary Young; Lawrence H Hanau; Phyllis Tien; Alexandra M Levine; Tracey E Wilson Journal: Am J Public Health Date: 2004-07 Impact factor: 9.308
Authors: Rochelle P Walensky; Sue J Goldie; Paul E Sax; Milton C Weinstein; A David Paltiel; April D Kimmel; George R Seage; Elena Losina; Hong Zhang; Runa Islam; Kenneth A Freedberg Journal: J Acquir Immune Defic Syndr Date: 2002-09-01 Impact factor: 3.731
Authors: Kevin P High; Mark Brennan-Ing; David B Clifford; Mardge H Cohen; Judith Currier; Steven G Deeks; Sherry Deren; Rita B Effros; Kelly Gebo; Jörg J Goronzy; Amy C Justice; Alan Landay; Jules Levin; Paolo G Miotti; Robert J Munk; Heidi Nass; Charles R Rinaldo; Michael G Shlipak; Russell Tracy; Victor Valcour; David E Vance; Jeremy D Walston; Paul Volberding Journal: J Acquir Immune Defic Syndr Date: 2012-07-01 Impact factor: 3.731
Authors: Thomas P Giordano; Glenn Bartsch; Yafeng Zhang; Ellen Tedaldi; Judith Absalon; Sharon Mannheimer; Avis Thomas; Rodger D MacArthur Journal: AIDS Patient Care STDS Date: 2010-05 Impact factor: 5.078
Authors: Bethany L Morris; Callie A Scott; Timothy J Wilkin; Paul E Sax; Roy M Gulick; Kenneth A Freedberg; Bruce R Schackman Journal: HIV Clin Trials Date: 2012 Jan-Feb
Authors: Mehri S McKellar; Maragatha N Kuchibhatla; Kris Ann K Oursler; Stephen Crystal; Kathleen M Akgün; Kristina Crothers; Cynthia L Gibert; Karen Nieves-Lugo; Julie Womack; Janet P Tate; Gerda G Fillenbaum Journal: AIDS Res Hum Retroviruses Date: 2019-06-18 Impact factor: 2.205
Authors: L Lourenço; H Samji; A Nohpal; W Chau; G Colley; K Lepik; R Barrios; V Lima; R S Hogg; Jsg Montaner; S Kesselring; D M Moore Journal: HIV Med Date: 2015-02-27 Impact factor: 3.180
Authors: Patricia Sweeney; Lytt I Gardner; Kate Buchacz; Pamela Morse Garland; Michael J Mugavero; Jeffrey T Bosshart; R Luke Shouse; Jeanne Bertolli Journal: Milbank Q Date: 2013-07-08 Impact factor: 4.911
Authors: Sheri D Weiser; Abigail Hatcher; Edward A Frongillo; David Guzman; Elise D Riley; David R Bangsberg; Margot B Kushel Journal: J Gen Intern Med Date: 2012-08-18 Impact factor: 5.128