People with HIV-AIDS who are treated promptly and properly have the same life expectancy as the uninfected, even in the poorest parts of Africa, new Canadian research shows.
The study, published in Tuesday's edition of the Annals of Internal Medicine, shows that patients in Uganda being treated with antiretroviral therapy at age 20 can expect to live, on average, to age 56.7. Average life expectancy in Uganda, where the study was conducted, is 55.
"HIV diagnosis and treatment in resource-limited settings should no longer be considered a death sentence," said Edward Mills, an associate researcher at the B.C. Centre for Excellence in HIV-AIDS. "Instead, HIV-infected people should plan and prepare for a long and fulfilling life."
Drug cocktails that suppress the human immunodeficiency virus and keep deadly infections at bay have already transformed HIV-AIDS into a chronic illness in the Western world.
But many have doubted the same was possible in Africa, where the epidemic has hit hardest. The new study seems to lay those worries to rest.
"The popular belief was that AIDS treatment was too complicated," Dr. Mills said. "That's nonsense. We can give the same effective treatment in Uganda as we do in Canada."
Antiretroviral therapy (ARV) is also relatively cheap - about $300 per person per year in the developing world. (In Canada, the cost is about $10,000 a year.)
The study involved 22,315 patients aged 14 and over treated at AIDS clinics in Uganda between 2000 and 2009. During the study period, 1,943 patients died.
Dr. Mills, who also holds the Canada research chair in global health at the University of Ottawa, said that while life expectancy rose sharply over all, there were troubling discrepancies in outcomes for men and women.
For those being treated for HIV-AIDS at age 20, life expectancy was an additional 19.1 years for men and 30.2 years for women. At age 35, life expectancy was 22 more years for males and 32.5 years for females. "The men are doing a lot worse than the women," Dr. Mills said.
There are several explanations for the gender differences: Men tend to seek treatment later, when the disease is more advanced, and are more likely not to receive follow-up care. Women are also more likely to be tested than men, in large part because HIV-AIDS tests are a routine part of pregnancy care.
The study notes that about 200,000 Ugandans are taking ARV therapy, but another 200,000 who need treatment do not have access. Across Africa, fewer than one-third of those who would benefit from treatment are getting the drug cocktails.
Dr. Mills said ARV has three principal benefits:
- It keeps people from dying so they can remain productive members of society;
- It provides a normal life expectancy, allowing families to remain intact;
- It makes those with HIV-AIDS far less likely to infect others, weakening the epidemic.
In fact, Canadians have been the leading proponents of the philosophy of "treatment as prevention," an approach that is picking up steam.
In the most recent edition of the medical journal The Lancet, Julio Montaner, director of the B.C. Centre for Excellence in HIV-AIDS, wrote: "The evidence is clear: Treatment conclusively prevents morbidity, mortality and transmission."
He cited new research from the U.S. National Institutes of Health that shows early treatment with drug cocktails reduces HIV transmission by 96 per cent in couples where one partner is infected.
Elly Katabira, president of the International AIDS Society, said that "treatment as prevention is one of the most important and promising additions to the range of prevention strategies available to us today."
An estimated 33.3 million people worldwide are living with HIV-AIDS, according to UNAIDS. An estimated 2.6 million people were newly infected last year, and about 1.8 million died of AIDS-related illnesses.
About 65,000 Canadians are living with HIV-AIDS, according to the Public Health Agency of Canada. There are somewhere between 2,300 and 4,300 new infections annually in this country, PHAC estimates.