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ESTIMATED LIFE EXPECTANCY GAINS WITH ANTIRETROVIRAL THERAPY AMONG ADULTS WITH HIV IN LATIN AMERICA AND THE CARIBBEAN: A MULTISITE RETROSPECTIVE COHORT STUDY
Author
Smiley, Casey L.
Rebeiro, Peter F.
Cesar, Carina
Belaunzaran-Zamudio, Pablo F.
Crabtree-Ramirez, Brenda
Padgett, Denis
Gotuzzo, Eduardo
Cortes, Claudia P.
Pape, Jean
Veloso, Valdiléa G.
McGowan, Catherine C.
Castilho, Jessica L.
Caribbean, Central and South America network for HIV epidemiology (CCASAnet)
Rebeiro, Peter F.
Cesar, Carina
Belaunzaran-Zamudio, Pablo F.
Crabtree-Ramirez, Brenda
Padgett, Denis
Gotuzzo, Eduardo
Cortes, Claudia P.
Pape, Jean
Veloso, Valdiléa G.
McGowan, Catherine C.
Castilho, Jessica L.
Caribbean, Central and South America network for HIV epidemiology (CCASAnet)
Affilliation
Department of Medicine, Vanderbilt University Medical Center. Nashville, TN, USA.
Vanderbilt University Medical Center Division of Infectious Diseases. Nashville, TN, USA / Vanderbilt University Medical Center. Division of Epidemiology and Department of Biostatistics. Nashville, TN, USA.
Fundación Huésped. Investigaciones Clínicas. Buenos Aires, Argentina.
Instituto Nacional de Ciencias Médicas y Nutrición. Departamento de Infectología. Salvador Zubirán, Mexico City, Mexico.
Instituto Nacional de Ciencias Médicas y Nutrición. Departamento de Infectología. Salvador Zubirán, Mexico City, Mexico.
Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario. Tegucigalpa, Honduras.
Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Peru.
Fundación Arriarán and University of Chile School of Medicine. Santiago, Chile.
Weill Cornell Medical College. Department of Medicine. Division of Infectious Diseases. Center for Global Health. New York City, NY, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
Vanderbilt University Medical Center Division of Infectious Diseases. Nashville, TN, USA / Vanderbilt University Medical Center. Division of Epidemiology and Department of Biostatistics. Nashville, TN, USA.
Fundación Huésped. Investigaciones Clínicas. Buenos Aires, Argentina.
Instituto Nacional de Ciencias Médicas y Nutrición. Departamento de Infectología. Salvador Zubirán, Mexico City, Mexico.
Instituto Nacional de Ciencias Médicas y Nutrición. Departamento de Infectología. Salvador Zubirán, Mexico City, Mexico.
Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario. Tegucigalpa, Honduras.
Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Peru.
Fundación Arriarán and University of Chile School of Medicine. Santiago, Chile.
Weill Cornell Medical College. Department of Medicine. Division of Infectious Diseases. Center for Global Health. New York City, NY, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
Vanderbilt University Medical Center. Division of Infectious Diseases. Nashville, TN, USA.
Abstract
BACKGROUND: Sparse data exist on life expectancy gains among persons living with HIV
(PWH) in low- and middle-income settings where antiretroviral therapy (ART) is increasingly
available. We calculated life expectancy trends among PWH initiating ART within the Caribbean,
Central and South America network for HIV epidemiology (CCASAnet).
METHODS: PWH initiating ART and ≥20 years old between 2003–2017 from CCASAnet sites
in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru contributed person-time until the
date of death, last contact, database closure, or December 2017. We used the Chiang method of
abridged life tables to estimate life expectancy at age 20 for three eras (2003–2008, 2009–2012,
and 2013–2017) overall and by demographic and clinical characteristics at ART initiation. We
used Poisson regression models to weight mortality rates to account for informative censoring.
FINDINGS: Among 30,688 PWH, 17,491 (57%) were from Haiti and 13,197 (43%) were from all
other sites. There were 1,470 deaths among PWH in Haiti and 1,167 deaths at other sites. Crude
and weighted mortality rates decreased among all age groups over calendar eras. From 2003–2008
to 2013–2017, overall life expectancy for PWH at age 20 years increased from 13·9 (95%
confidence interval [CI]: 12·5–15·2]) to 61·2 years (95%CI: 59·0–63·4) at Haiti and from 31·0
(95% CI: 29·3–32·8) to 69·5 years (95% CI: 67·2–71·8) at all other sites, approaching life
expectancies of the general population (69·9 years in Haiti and 78·0 years at all other sites).
However, disparities in life expectancy by sex/sexual HIV transmission risk factor, CD4 cell count,
education, and tuberculosis at or prior to ART persisted across calendar eras.
INTERPRETATION: Life expectancy among PWH on ART has significantly improved in Latin
America. Persistent disparities in life expectancy by demographic and clinical factors at ART
initiation highlight vulnerable populations in the region.
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