Life expectancy of people with HIV on antiretroviral therapy in Spain.

OBJECTIVE: To estimate life expectancy (LE) of people with HIV (PWH) and describe causes of death.

DESIGN: ART-naïve adults from the CoRIS cohort starting ART in 2004-2019.

METHODS: We calculated LE at age 40 for men and women according to their ART initiation period, and stratified by transmission category, CD4 count and AIDS diagnosis.We estimated LE in 10-year age bands using life tables constructed from mortality rates, estimated through Poisson models.

RESULTS: LE increased from 65.8 (95%CI: 65.0-66.6) in 2004-2008 to 72.9 (72.2-73.7) in 2014-2019 in men (general population comparators [GPC]:79.1 and 81.2 years, respectively) and from 65.8 (65.0-66.6) to 72.5 (71.8-73.3) in women (GPC: 84.9 and 86.4, respectively). Non-AIDS-related deaths accounted for 68% of deaths among men and 78% among women. LE was longer when starting ART with higher CD4 counts and without AIDS. For men acquiring HIV through sex with men, starting ART in 2014-2019 without AIDS, LE was 75.0 (74.2-75.7) with CD4<200 cells/μL, rising to 78.1 (77.5-78.8) with CD4≥350 cells/μL. Corresponding figures were 70.1 (69.4-70.9) and 76.0 (75.3-76.7) for men acquiring HIV heterosexually (HTX) and 61.5 (60.7-62.3) and 69.0 (68.2-69.8) for those acquiring HIV through injection drug use (IDU). For women starting ART from 2014 without AIDS, LE increased from 71.7 (71.0-72.4) to 77.3 (76.7-77.9) among HTX and from 63.7 (62.9-64.5) to 70.7 (70.0-71.5) among IDU.

CONCLUSIONS: Our findings confirm the progressive improvement of LE in PWH in Spain over the last decades, supporting the insurability of PWH on suppressive ART in our current setting and time.