HIV Therapies Provide Near Normal Lifespan in Africa
OTTAWA - A landmark study by the University of Ottawa and the BC Centre for Excellence in HIV/AIDS (BC-CfE) shows that patients in Africa receiving combination antiretroviral therapy for HIV can expect to live a near normal lifespan.
The study, published in the Annals of Internal Medicine and funded by the Canadian Institutes of Health Research, is the first large-scale analysis of life expectancy outcomes in Africa for HIV patients on cART. It shows significant variance between patient subgroups. Females have a significantly higher life expectancy than men, and early initiation of treatment was associated with longer life expectancy in all participants.
“The substantial life expectancy afforded by widespread access to cART underscores the fact that HIV diagnosis in resource-limited settings should no longer be considered a death sentence,” said principal investigator Edward Mills, PhD, professor in the Interdisciplinary School of Health Sciences at the Faculty of Health Sciences and Canada Research Chair in Global Health at the University of Ottawa.
The authors believe that the study, conducted in Uganda, reflects the situation in many other settings in Africa where simplified HIV/AIDS care in rural, semi-rural and urban settings is available. It reinforces the need to fund and expand simplified HIV programs that deliver significant, life-saving health benefits in resource-challenged settings.
“Our findings are further evidence that the global investment in HIV and AIDS programming is clearly working,” said Dr. Mark Dybul, a study author who led the implementation of the multibillion-dollar U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) from 2006-2009 and now works at Georgetown University and the George W. Bush Institute.
The study analyzed a cohort of 22,315 individuals who initiated cART at The AIDS Support Organization (TASO) clinics between 2000 and 2009. In Uganda, life expectancy at birth is approximately 55 years and increases as individuals survive key milestones. Life expectancy at age 20 for the overall study cohort on cART was an additional 26.7 years and at age 35 an additional 27.9 years.
“These benefits will only be sustained if there is continued support for cART scale-up by the international donor community and national governments,” said study author Dr. Jean Nachega, professor of medicine and director of the Centre for Infectious Diseases at Stellenbosch University, Cape Town, South Africa. “We require sustainable investment and simplified treatment options to deliver long-term care and access more people in Africa with HIV.”
Although more than 200,000 patients are receiving cART in Uganda, about 200,000 more Ugandans await cART initiation.
The study findings also support the Treatment as Prevention strategy pioneered at the BC-CfE and adopted by the Joint United Nations Programme on HIV/AIDS (UNAIDS) as a key pillar of its Treatment 2.0 initiative, the cornerstone of the so called “Prevention Revolution.” Treatment as Prevention, which calls for extensive HIV testing and greater access to treatment for medically eligible people living with HIV, could be an effective component of combination prevention strategies.