Survival of Persons with and without HIV Infection in Denmark, 1995–2005

16 January 2007 | Volume 146 Issue 2 | Pages 87-95

Background: The expected survival of HIV-infected patients is of major public health interest.

Objective: To estimate survival time and age-specific mortality rates of an HIV-infected population compared with that of the general population.

Design: Population-based cohort study.

Setting: All HIV-infected persons receiving care in Denmark from 1995 to 2005.

Patients: Each member of the nationwide Danish HIV Cohort Study was matched with as many as 99 persons from the general population according to sex, date of birth, and municipality of residence.

Measurements: The authors computed Kaplan–Meier life tables with age as the time scale to estimate survival from age 25 years. Patients with HIV infection and corresponding persons from the general population were observed from the date of the patient's HIV diagnosis until death, emigration, or 1 May 2005.

Results: 3990 HIV-infected patients and 379 872 persons from the general population were included in the study, yielding 22 744 (median, 5.8 y/person) and 2 689 287 (median, 8.4 years/person) person-years of observation. Three percent of participants were lost to follow-up. From age 25 years, the median survival was 19.9 years (95% CI, 18.5 to 21.3) among patients with HIV infection and 51.1 years (CI, 50.9 to 51.5) among the general population. For HIV-infected patients, survival increased to 32.5 years (CI, 29.4 to 34.7) during the 2000 to 2005 period. In the subgroup that excluded persons with known hepatitis C coinfection (16%), median survival was 38.9 years (CI, 35.4 to 40.1) during this same period. The relative mortality rates for patients with HIV infection compared with those for the general population decreased with increasing age, whereas the excess mortality rate increased with increasing age.

Limitations: The observed mortality rates are assumed to apply beyond the current maximum observation time of 10 years.

Conclusions: The estimated median survival is more than 35 years for a young person diagnosed with HIV infection in the late highly active antiretroviral therapy era. However, an ongoing effort is still needed to further reduce mortality rates for these persons compared with the general population.

Editors' Notes Context The expected survival of HIV-infected patients has been difficult to measure by comparing selected HIV samples and control groups. Contribution Denmark carefully tracks each of its residents' vital status, which makes it possible to accurately compare survival of HIV-infected persons and uninfected persons. In 2000 to 2005, life expectancy at age 25 years was 51 years in the general population and 39 years for HIV-infected persons without hepatitis C virus infection (HCV). Cautions Denmark provides excellent access to HIV and HCV care, so the results may be atypical. Implications Persons with HIV infection have a good, but far from normal, life expectancy. —The Editors

 

Author and Article Information

From Odense University Hospital and University of Southern Denmark, Odense, Denmark; Århus University Hospital and Århus University, Århus, Denmark; Hvidovre University Hospital, Hvidovre, Denmark; Rigshospitalet, Copenhagen, Denmark; and Boston University, Boston, Massachusetts.

Acknowledgments: The authors thank the staff of their clinical departments for their continuous support and enthusiasm.

Grant Support: The Danish HIV Cohort study receives funding from the Danish AIDS Foundation, Odense University Hospital, Preben and Anna Simonsen's Foundation, the Foundation of the Danish Association of Pharmacists, and the Clinical Institute at the University of Southern Denmark.

Potential Financial Conflicts of Interest: Consultancies: J. Gerstoft (Roche, Glaxo, Abbott, Boehringer Ingelheim, Merck Sharp & Dohme, Swedish-Orphan Drugs); Honoraria: J. Gerstoft (Roche, Glaxo, Abbott, Boehringer Ingelheim, MSD, Swedish-Orphan Drugs); Grants received: N. Obel (Roche, Bristol-Meyers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, Abbott, Boehringer Ingelheim, Janssen-Cilag, Swedish-Orphan Drugs).

Requests for Single Reprints: Nicolai Lohse, MD, PhD, Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; e-mail, nl{at}dce.au.dk.

Current Author Addresses: Drs. Lohse, Hansen, and Obul: Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.

Dr. Pedersen: Department of Infectious Diseases, Aalborg University Hospital, DK-9000 Aalborg, Denmark.

Dr. Kronborg: Department of Infectious Diseases, Hvidovre Hospital, DK-2650 Hvidovre, Denmark.

Dr. Gerstoft, Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.

Dr. Sørensen: Department of Clinical Epidemiology, Århus University Hospital, Ole Worms Allé 1150, DK-8000 Århus C, Århus, Denmark.

Dr. Væth: Department of Biostatistics, University of Århus, DK-8000 Århus C, Denmark.

Author Contributions: Conception and design: N. Lohse, A.-B.E. Hansen, H.T. Sørensen, N. Obel.

Analysis and interpretation of the data: N. Lohse, H.T. Sørensen, M. Væth, N. Obel.

Drafting of the article: N. Lohse.

Critical revision of the article for important intellectual content: N. Lohse, A.-B.E. Hansen, G. Pedersen, G. Kronborg, J. Gerstoft, H.T. Sørensen, M. Væth, N. Obel.

Final approval of the article: N. Lohse, A.-B.E. Hansen, G. Pedersen, G. Kronborg, J. Gerstoft, H.T. Sørensen, M. Væth, N. Obel.

Provision of study materials or patients: G. Pedersen, G. Kronborg, J. Gerstoft, N. Obel.

Statistical expertise: N. Lohse, M. Væth.

Obtaining of funding: N. Obel.

Administrative, technical, or logistic support: N. Lohse, N. Obel.

Collection and assembly of data: N. Lohse, A.-B.E. Hansen, G. Kronborg, J. Gerstoft, N. Obel.