Long-term mortality in HIV-infected individuals 50 years or older: a nationwide, population-based cohort study

BACKGROUND: Although the prevalence of HIV-infection among individuals ≥ 50 years of age has increased, the impact of HIV-infection on risk of death in this population remains to be established. Our aim was to estimate long-term mortality among HIV-infected individuals who were 50 years or older, when compared to an individually-matched cohort from the background population.

METHODS: Population-based cohort-study including HIV-infected individuals ≥ 50 years, who were alive one year after HIV-diagnosis (n=2,440) and a comparison cohort individually-matched by age and gender extracted from the background population (n=14,588). Cumulative survival was evaluated using Kaplan-Meier method and Mortality Rate Ratios (MRRs) were estimated using Cox Regression Models. Study period 1996-2014.

RESULTS: Estimated median survival time from age 50 years for HIV-infected individuals increased from 11.8 years (95% CI; 10.2-14.5) during 1996-1999 to 22.8 years (20.0-24.2) in 2006-2014. MRR decreased with increasing age from 3.8 (3.1-4.7) for 50-55 years to 1.6 (1.0-2.6) for 75-80 years. In a cohort of well-treated HIV-infected individuals ≥ 50 years without AIDS-defining events or comorbidity at study inclusion (n=517). MRR was 1.7 (1.2-2.3) compared to population controls without comorbidity.

CONCLUSION: Among HIV-infected individuals estimated median survival time from age 50 years has increased by more than 10 years from 1996-1999 to 2006-2014, but is still substantially lower than in the background population. Even among well-treated HIV-infected individuals ≥ 50 years without comorbidity or AIDS-defining events the estimated median survival time remains lower than in the general population.