Background:  To characterize changes in mortality and life expectancy among HIV⁺ persons initiating combination ART (cART).

Methods:  The Antiretroviral Cohort Collaboration (ART-CC) is a multinational cohort study of ART-naive patients initiating cART in Europe and North America. Patients were included in this analysis if they were on cART for at least a year. The primary endpoint was all-cause mortality. Abridged life tables were constructed to estimate life expectancies among ART-naive persons at the time of initiating cART in 3 periods 1996-1999, 2000-2002, and 2003-2005. These tables were stratified by gender, baseline CD4 cell count, and history of injection drug use. For this exercise, the expectation of life at age 20 years was reported and refers to the average number of years remaining to be lived by those initiating cART at that age. Potential years of life lost from 20 to 65 years and crude death rates were also calculated for this exercise.

Results:  A total of 14,993, 9895, and 3614 patients initiated and were on cART for at least 1 year in 1996-1999, 2000-2002, and 2003-2005, respectively. A total of 1531 (5.4%) deaths were observed in this population during the study period with crude death rates decreasing from 45.1 deaths per 1000 person years in 1996-1999 to 27.8 deaths per 1000 person-years in 2003-2005. Potential years of life lost per 1000 person-years also decreased over the same time interval from 1796.7 to 1296.2. Life expectancy at exact age 20 years increased from 24.3 years (standard error, SE, 0.8) to 33.2 (SE 0.8) during this time span. Life expectancy levels were comparable for men and women at 33.5 years (SE 1.2) and 33.0 years (SE 1.3), respectively in 2003-2005. Patients with a history of injection drug use had significantly lower life expectancies than those from other transmission groups (28.2 years, SE 1.0, vs 34.7 years, SE 0.9, in 2003-2005). During 2003-2005, life expectancy decreased at lower baseline CD4 counts, ranging from 38.3 years (SE 0.8) for those with baseline CD4 counts of ≥350 cells/mm³ to 30.9 (SE 1.3) for those with baseline CD4 counts of <200 cells/mm³.

Conclusions:  The average number of years remaining to be lived by those initiating cART at age 20 years were approximately half those observed among the general population in these countries. In the United States, life expectancy at age 20 years was 58.3 years in 2003.