The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia.
AIDS. 2013 May 15;27(8):1245-51. doi: 10.1097/QAD.0b013e32835e163d.
Combination antiretroviral therapy (cART) has greatly improved the life expectancy of people living with HIV (PLHIV). Our study aims to project the life expectancy of PLHIV in a resource-rich setting in the context of the currently available antiretroviral treatments.
Patient antiretroviral treatment data were sourced from an observational cohort of 3434 predominantly male (94.2%) PLHIV in Australia over the period 1997-2010. These data were analyzed in a computer simulation model to calculate the distribution of time until exhaustion of all treatment options and expected effect on mortality. Standardized mortality ratios were used to simulate expected survival before and after treatment exhaustion.
We estimated that the median time until exhaustion of currently available treatment options is 45.5 years [interquartile range (IQR) 34.0-61.0 years]. However, 10% of PLHIV are expected to exhaust all currently available cART options after just 25.6 years. PLHIV who start currently available cART regimens at age 20 years are expected to live to a median age of 67.4 (IQR 53.2-77.7) years. This is a substantial improvement on no cART [27.7 (IQR 23.8-32.0) years] but is still substantially less than the median general population mortality age [82.2 (IQR 74.0-87.8) years]. The life expectancy gap between PLHIV and the general population is greatest for those infected at younger ages.
As treatment options are exhausted, a substantial difference in life expectancy between PLHIV and the general population could be expected even in resource-rich settings, particularly for people who acquire HIV at a younger age or who are currently highly treatment experienced.
联合抗逆转录病毒疗法（cART）极大地提高了艾滋病毒感染者（PLHIV）的预期寿命。本研究旨在根据目前可用的抗逆转录病毒治疗方法，预测资源丰富环境下 PLHIV 的预期寿命。
患者抗逆转录病毒治疗数据来自澳大利亚一个观察性队列中的 3434 名主要为男性（94.2%）的 PLHIV，时间跨度为 1997 年至 2010 年。这些数据在计算机模拟模型中进行了分析，以计算所有治疗方案用尽的时间分布和对死亡率的预期影响。标准化死亡率用于模拟治疗耗尽前后的预期生存。
我们估计，目前可用治疗方案用尽的中位时间为 45.5 年[四分位距（IQR）34.0-61.0 年]。然而，预计 10%的 PLHIV 在仅仅 25.6 年后就会用尽所有现有的 cART 方案。20 岁开始使用现有 cART 方案的 PLHIV 预计平均寿命为 67.4 岁（IQR 53.2-77.7）。这与没有 cART[27.7（IQR 23.8-32.0）年]相比有了显著提高，但仍远低于一般人群的中位死亡率年龄[82.2（IQR 74.0-87.8）年]。在资源丰富的环境中，PLHIV 和一般人群之间的预期寿命差距在感染年龄较小的人群中最大。
随着治疗方案的用尽，即使在资源丰富的环境中，PLHIV 和一般人群之间的预期寿命差距也可能会显著扩大，尤其是在年轻时感染或目前高度治疗经验的人群中。
