A new paper from medical journal The Lancet has reported that people with HIV diagnosed today can expect the same life expectancy of the general population.
For years now we’ve referred to people living with HIV as having a “near normal” life expectancy, but according to this paper from The Lancet we’ve now reached a point where people with HIV can have an actual normal life expectancy.
The research team looked at data from 88,500 people with HIV from Europe and North America who had been involved in 18 studies.
Twenty-year olds who were diagnosed and started antiretroviral treatment in 2010 are expected to live an additional 10 years compared to those diagnosed and starting treatment in 1996.
The authors of the paper put the increase in life expectancy down to a number of factors.
- Improved, and constantly improving, antiretroviral treatments. In the last couple of decades we’ve seen numerous new treatments come onto the scene including the advent of integrase inhibitors like Dolutegravir and reformulations of existing drugs – such as tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF).
- Improved adherence, which may be down to newer antiretroviral treatments being easier to take (less pills) and easier to tolerate (fewer side effects).
- Better management of comorbidities. Twenty years on we’re much more able to diagnose, manage and/or treat a range of comorbidities.
There are, however, caveats.
Achieving a normal life expectancy is dependant on an early diagnosis and starting treatment soon after that diagnosis. Currently 39% of people diagnosed with HIV each year are diagnosed late – this means after the point when they should already have started treatment. People who’re diagnosed late have a ten-fold increase in the chance of dying in the first three years. People who inject drugs also are still struggling to achieve the increased life expectancy.
Jo Josh, a woman living with HIV, spoke to the BBC about life with HIV, the stigma that still affects people living with HIV and the challenges for people ageing with HIV today. You can watch her video below.
- Doctor Steve Taylor, Birmingham Heartlands HIV Service.
Doctor Steve Taylor, HIV Specialist at Birmingham Heartlands HIV Service and Medical Director to Saving Lives UK, said on today’s news:
“It’s incredibly encouraging to see confirmed what those of us working in clinic have suspected for many years. Early diagnosis and starting treatment early means people diagnosed with HIV today can expect a long and healthy life.
This can only happen, however, if people get tested. We still believe that there are around 13,000 people in the UK who have HIV but remain undiagnosed. It’s easier than ever to get tested for HIV, you can do it in clinics, in community settings and even at home using services like TakeATestUK.com (use voucher code ‘SAVE17’ for a free home HIV test kit).”
You can read the full paper over at The Lancet website.
This was the week when the UK voted to leave the European Union, Sonic the Hedgehog turned 25 years old and astronaut Tim Peake returned to Earth from the International Space Station.
Meanwhile in the world of HIV…
Miss Universe gets an HIV test to promote HIV testing on American HIV Testing Day (Huffington Post)
Born in Germany, and raised in the Philippines, Pia Wurtzbach now lives in New York after winning Miss Universe in 2015. Whilst living in the Philippines she worked with a number of HIV/AIDS charities and continues to raise awareness now using the platform given to her with her title. She was tested with a 4th Gen Alere test. Speaking to the crowd Pia said “National HIV Testing Day is a reminder to get tested, and take care of not only your health, but your love ones’ health too. It is important to know the facts, and be proactive about protecting yourself, your partners and your community.”
Surge in HIV Testing, yet 1 in 4 gay and bisexual men have never been tested (Huffington Post)
A new survey has shown that more people than ever are testing for HIV in the UK, the National Gay Men’s Sex Survey, found that 77% of gay and bisexual men had been tested for HIV the highest figure yet, but nearly one in four still have never been tested. Cary James, head of health promotion at THT, said “Knowing your HIV status is key to tackling the HIV epidemic, as people who are on treatment are highly unlikely to pass on the virus, so it’s really important to get tested. Testing is fast, easy and confidential.”
HIV care facing funding crisis (BBC News / Victoria Derbyshire)
There are over 100,000 people living with HIV and that figure increases every day. Six years ago the government removed ring fencing for HIV support service funding and now funding is at an all time low. Services and charities across the country are under pressure. In the past week Birmingham based HIV charity ABplus have announced that they will be closing their doors on the 8th July for the last time. BASELINE’s Robert Fieldhouse said on the Victoria Derbyshire show: ”You have to understand the situations people live in, abject poverty. We have a food bank where people can go twice a week and get a free meal, this is a service that costs [the council] £2 per person per day to access – that’s dirt cheap… We talk too much time talking about cost, and not enough time talking about value”
It’s great to see England doing so well at the Women’s World Cup – especially when so many of our Saving Lives ambassadors and supporters are part of the squad! The team secured its place in the final 16 on Wednesday night, so it’s now through to the knock-out stages and further glory for them – bring it on!
Congratulations to Darren Bent, one of our longest standing Saving lives Ambassadors, on his permanent move to Derby County FC:
Darren Bent says he ‘couldn’t see himself playing anywhere else’ once the possibility of joining Derby County permanently arose.
The 31-year-old striker today signed a two-year contract, with the option of a further year, following a successful loan spell from Premier League Aston Villa last season.
Bent scored 12 times in 17 appearances in the second half of the last term and expressed a strong desire to join the club on a permanent basis with his contract at Villa Park coming to an end this summer.
Saving Lives Patron, Professor Jane Anders0n, and Saving Lives Ambassador, Carl Froch, have both been featured in this year’s Queen’s Birthday Honours list. Jane, a former Chair of the British HIV Association, was awarded a CBE “for services to HIV Medicine and Sexual Health Research.” Meanwhile, Carl, the current WBC world super middleweight champion, was made an MBE for services to boxing. Congratulations to them both!
This arrived in the Saving Lives offices this morning: what does everything think about Vangardist magazine printing an issue with HIV-positive blood in the ink? We think it’s a fantastic way of commenting on, challenging, and combatting stigma and the common misconceptions about how HIV is transmitted.
The magazine came to us all the way from Austria – who else has a copy?
NHS England has approved an £18.7 million investment in a new drug for the treatment of hepatitis C.
Around 500 patients with acute liver failure, and/or awaiting liver transplantation, are expected to benefit from the decision to fund Sofosbuvir.
The hepatitis C virus causes inflammation of the liver, affecting its ability to function. Whilst many sufferers naturally clear their infections within six months, others develop chronic hepatitis which is usually life-long without therapy.
Current estimates indicate that around 30% of people infected with chronic hepatitis C will develop cirrhosis of the liver which, in some cases, may prove fatal without a liver transplant.
The recommendation of NHS England’s Clinical Priorities Advisory Group (CPAG) means that whilst not yet NICE-approved, Sofosbuvir will be funded for those patients at significant risk of mortality or who require transplantation.
View NHS England’s policy statement on the funding of Sofosbuvir. The drug, which will be available as an oral formulation, will be used in combination with another antiviral agent.
James Palmer, Clinical Director, Specialised Services, said:
“This is a major step forward for patients with this debilitating, and often life-threatening, disease and is evidence of NHS England’s commitment to widen access to cutting edge drugs, treatments and therapies where both clinically appropriate and cost effective.
“The majority of these patients will already be under the care of a specialist treatment centre, and we will ensure that clinicians are aware of this policy, so that all eligible patients have the opportunity to access this drug”.
Professor Graham Foster, Professor of Hepatology and co-Chair of the Hepatitis C Clinical Reference Group sub-group welcomed the news. He said:
“The recently licensed, new, direct-ac ting antiviral drugs for hepatitis C may be life-saving for infected patients with advanced cirrhosis. I am delighted that NHS England will make these drugs available for these patients and allow us to treat those in urgent need.
“The availability of these drugs will ensure that NHS patients are among the first in Europe to benefit from these revolutionary new drugs”.
NICE is currently developing Technology Appraisal Guidance relating to Sofosbuvir, which is due to be published later this year. The NHS England policy position will be reviewed once NICE has published this guidance.
Simon Collins, HIV i-Base and Saving Lives Adviser
On 27 May 2015, at least 18 months earlier than anyone expected, one of the largest ongoing HIV studies announced early results.
The news was given at a high-level press conference in Washington by Dr Antony Fauci, head of the US National Institute for Allergy and Immune Diseases (NIAID).
Together with the surprise timing, the results themselves were also not what anyone predicted.
The press release was right to say that the results will change HIV treatment guidelines across the world.
What is the study and the key results
This is an international study called Strategic Timing of AntiRetroviral Treatment (START).
Since 2009, it has been studying the impact of early treatment. This involved either starting when their CD4 count was still above 500 or waiting until it reached 350.
The excitement over the results is not just for doctors and researchers. The results are important for HIV positive people.
Main findings include:
- HIV treatment was safe for people starting HIV meds with a high CD4 count. Many people in START had a CD4 count above 800.
- Early treatment led to fewer serious HIV illnesses, even at high CD4 counts.
- The biggest impact from early treatment was expected to be on illnesses like heart, liver and kidney disease and some non-HIV cancers. The opposite was true. This is big news.
- The results were similar in in both low- and high-income countries. This should result in making HIV treatment more available in all countries.
Everyone in START will now have the chance to start early treatment, even at very high CD4 counts.
Why are the results so exciting?
The START results are important is for at least three related reasons.
Firstly, they will change the way HIV reatment is prescribed. For the last 30 years, most decisions to treat HIV has depended on the CD4 count dropping to a certain level. START should mean that the next step after an HIV diagnosis will now be treatment.
Secondly, the results show that benefits of treatment and prevention overlap. Other studies have proven that treatment dramatically reduces HIV transmission. Now people using treatment as prevention (TasP) will know there are direct benefits for their own health too.
Thirdly, this will make it easier to design programmes to end the AIDS epidemic.
Who was enrolled in START?
Any research study is really a story about real people and the HIV positive volunteers in START were interesting and diverse.
People were enrolled from 35 countries: from Europe, North and South America, Africa, Asia and Australia.
About half were gay men and more than 1 in 4 were women. The average age was 36 but ranged from 18 to 81.
Everyone started with a CD4 count above 500 and the study followed people for an average of 3 years.
However, just as in the general population, people had other health issues.
- One third were current smokers.
- Half had one or more risks for heart disease.
- One in five had complications of high blood pressure.
The study included people with diabetes, hepatitis coinfection, people with alcohol and drug issues, and psychological problems including depression.
How much better was early treatment?
Because of the high CD4 counts, the risk of HIV illnesses was expected to be very low. This was shown in the overall results.
Less than 3% of people had serious complications. The number of these cases was lower than expected in both groups. However, the differences between the two groups was big enough to change the study. Early treatment will now be offered to everyone in the study.
People in the early treatment group had roughly half the risk of a serious HIV related illness (reduced by 53%). The comparison with people starting later was very significant.
The early group had fewer cases of two HIV-related cancers – Kaposi’s Sarcoma (KS) and non-Hodgkin lymphoma (NHL), and fewer cases of tuberculosis (TB).
More details about these results are in the Q&A below.
Were there risks from earlier treatment?
Because only early results are released, we need to wait for details about specific risks.
We don’t know how many people became undetectable on treatment. We don’t have specific information about side effects. We don’t know whether drug resistance will be an important caution.
We also don’t know about how treatment affects overall quality of life.
As well as the main study, several sub-studies looked at these issues.
In general though, the lower number of very serious illnesses is likely to still mean that the benefits of early treatment outweigh the risks.
What happens now?
The study is going to continue to follow everyone in the study.
- People who are already on treatment will continue with the same treatment and monitoring.
- People in START who are not yet on treatment will now be offered treatment.
Over the next two months, the researchers will collect outstanding information. This will go into a more detailed analysis.
These results are likely to be presented at the International AIDS Conference being held in Vancouver in July 2015. The results from the sub-studies will also be presented.
START has created a cohort of people that might have potential advantages for long-term follow-up that will never again be possible.
When the study eventually closes, there is a commitment to continue providing treatment for at least six months. This is so the health providers in each country take on this responsibility.
The START study was rooted in a community demand for good evidence.
When there is not good evidence we have to rely on expert opinion. The lack of evidence often meant that guidelines in the past did not always get it right. The early years of HIV treatment included many examples of guideline changes after evidence became available.
The START study is therefore an important achievement for asking for evidence over opinion. Good evidence is an essential step towards getting good care. This might even be more important that the overall finding that supports use of ART at any CD4 count: it is the level of confidence that can be relied on when discussing the important question of when to start treatment.
With over 12 million people on HIV treatment globally, the decision for the best time to start treatment was too important not to want the best quality evidence. This involved a randomised study. It also involved several thousand people volunteering to be part of the study.
A lot has happened since the first person enrolled. Early discussions about the study in 2009 included a worry that people might never agree to start at such high CD4 counts.
It was also unsettling that not everyone supported the study, when all we were really asking for was good evidence. It was even unsettling to see how passionately some people objected to START.
The results show exactly why the study was needed. Nobody thought that early treatment would reduce AIDS events at very high CD4 counts.
It is significant that most people who joined the study, stayed in the study. More people stayed connected to for their care than is commonly reported even for a study of a new drug treatment.
So before going on to the many debates about the results, it is good to first pause for a moment to acknowledge the research team that drove this study and the HIV positive people without which none of this would have been possible.
It is with great sadness that we received news today of the death of Professor Martin Fisher. Saving Live extends its deepest condolences to Martin’s partner, Adrian, as well as his family, friends and colleagues. Martin was due to give the keynote address at this year’s annual BHIVA conference, in his hometown of Brighton, and our thoughts at this time are with all who knew him.
Professor Martin Fisher was the first professor of HIV medicine at Brighton & Sussex Medical School. He was an honorary consultant physician in sexual health & HIV at BSUH. He had been instrumental in the development of the department since being in post in 1995. He was a leading UK HIV physician and researcher. and an active member of the British HIV association (BHIVA) since its inception, a former Secretary, and Chair of the Guidelines Subcommittee, co-chair of HIV testing guidelines, and a member of guideline writing groups including ART, hepatitis, opportunistic infections and PEPSE.
Our Medical Director Dr Steve Taylor said: “Hearing of Martin’s Death has stunned the UK’s HIV and Sexual Health community. He was an inspirational HIV Physician, and worked tirelessly to further HIV research, patient care and teaching. He was the ultimate champion of HIV and HIV testing – and never stopped raising awareness at every opportunity. He will be greatly missed by his many friends, patients and colleagues alike.”