HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, UK.
AIDS. 2012 Jan 28;26(3):335-43. doi: 10.1097/QAD.0b013e32834dcec9.
Effective antiretroviral therapy (ART) has contributed greatly toward survival for people with HIV, yet many remain undiagnosed until very late. Our aims were to estimate the life expectancy of an HIV-infected MSM living in a developed country with extensive access to ART and healthcare, and to assess the effect of late diagnosis on life expectancy.
A stochastic computer simulation model of HIV infection and the effect of ART was used to estimate life expectancy and determine the distribution of potential lifetime outcomes of an MSM, aged 30 years, who becomes HIV positive in 2010. The effect of altering the diagnosis rate was investigated.
Assuming a high rate of HIV diagnosis (median CD4 cell count at diagnosis, 432 cells/μl), projected median age at death (life expectancy) was 75.0 years. This implies 7.0 years of life were lost on average due to HIV. Cumulative risks of death by 5 and 10 years after infection were 2.3 and 5.2%, respectively. The 95% uncertainty bound for life expectancy was (68.0,77.3) years. When a low diagnosis rate was assumed (diagnosis only when symptomatic, median CD4 cell count 140 cells/μl), life expectancy was 71.5 years, implying an average 10.5 years of life lost due to HIV.
If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals. The greatest risk of excess mortality is due to delays in HIV diagnosis.
有效的抗逆转录病毒疗法（ART）极大地提高了 HIV 感染者的生存率，但许多人直到很晚才被诊断出来。我们的目的是估计在一个拥有广泛 ART 和医疗保健资源的发达国家中，感染 HIV 的男男性行为者（MSM）的预期寿命，并评估晚期诊断对预期寿命的影响。
使用 HIV 感染和 ART 效果的随机计算机模拟模型来估计预期寿命，并确定在 2010 年感染 HIV 的 30 岁 MSM 的潜在终生结果的分布。研究了改变诊断率的效果。
假设高 HIV 诊断率（诊断时的中位数 CD4 细胞计数，432 个/μl），预计死亡的中位数年龄（预期寿命）为 75.0 岁。这意味着平均因 HIV 损失了 7.0 年的寿命。感染后 5 年和 10 年的累积死亡风险分别为 2.3%和 5.2%。预期寿命的 95%置信区间为（68.0，77.3）年。当假设低诊断率（仅在出现症状时诊断，中位数 CD4 细胞计数 140 个/μl）时，预期寿命为 71.5 岁，这意味着因 HIV 损失了平均 10.5 年的寿命。
如果在接受治疗的患者中观察到的病毒学失败率继续保持低水平，那么能够广泛使用抗逆转录病毒药物的 HIV 感染者的预期寿命相对较高。由于 HIV 诊断延迟，导致超额死亡率的风险最大。
