Background:  Prognostic models have been developed to estimate survival probabilities of HIV-infected patients treated with combination antiretroviral therapy (cART). For patients not yet eligible for cART few prognostic models are available.

Methods:  From 1998 to 2007, 4174 patients diagnosed with HIV and still cART-naïve at 24 weeks after diagnosis were selected from the ATHENA national observational cohort. Patients presenting late in their infection, i.e. who had an AIDS event or who started cART before 24 weeks, were excluded. Progression to death compared to the age and gender-matched general Dutch population was studied with a multivariate hazards model. Treatment with cART after 24 weeks was not explicitly captured by the model, but was assumed to be started according to current treatment guidelines. The predicted survival distributions were used to calculate the life expectancy of HIV-infected patients and the difference in life expectancy with matched uninfected individuals.

Results:  During 15,644 person-years of follow-up since 24 weeks after diagnosis, 76 deaths occurred of which 30 occurred before initiating cART, yielding a mortality rate of 4.9 (95%CI, 3.8 to 6.1) per 1000 person-years. Median CD4 counts at 24 weeks were 490 interquartile range (IQR) 370 to 660) cells/mm³ and median follow-up time was 3.3 (IQR 1.5 to 5.7) years. Only age at 24 weeks (hazard ratio 1.07, 95%CI 1.03 to 1.10, per year older) and CDC stage B (4.8, 2.1 to 11.3) were associated with progression to death. According to the model, the median number of years lived from diagnosis at age 25 was 52.4 (IQR 43.5 to 59.2; general population 53.1) and 57.4 (48.5 to 63.5; 58.1) for HIV-infected men and women, respectively. The difference in life expectancy varied between 0.7 years if diagnosed with HIV at age 25 and 2.1 if diagnosed at age 55; for patients with a CDC-B event this range was 3.6 to 11.7 years. In an alternative model that fit the data equally well and included current age in each year of follow-up, the difference in life expectancy was 4.8 years if diagnosed at age 25 and 3.8 at age 55 years.

Conclusions:  The life expectancy of asymptomatic HIV-infected patients who are still treatment-naive and have not experienced a CDC-B or C event at 24 weeks after diagnosis approaches that of age and gender-matched uninfected individuals. However, follow-up time was short compared to the expected number of years lived and predictions depend on continuing success of cART well after the maximum follow-up time.