Life Expectancy after Initiation of Combination Antiretroviral Therapy in Thailand

Background Access to combination antiretroviral therapy (cART) has decreased mortality in HIV-positive people. We aimed to estimate the expected additional years of life in HIV-positive Thai people after starting cART through the National AIDS Program (NAP), administered by the Thai National Health Security Office (NHSO). Methods The NHSO database collects characteristics of all Thai HIV-infected patients through the National AIDS Program, including linkage with the National Death Registry for vital status. This study included patients aged ≥15 years at cART initiation between 2008 and 2014. The abridged life table method was used to construct life tables stratified by sex and baseline CD4 + T-cell count. Life expectancy was defined as the additional years of life from age at starting cART. Results 201,688 eligible patients were included in analyses, contributing 618,837 person-years of follow-up. Median CD4 + T-cell count was 109 cells/mm 3 and median age 37 years. The overall life expectancy after cART initiation at age 20 was 25.4 (95% CI, 25.3, 25.6) years and 20.6 (95% CI, 20.5, 20.7) at age 35 years. Life expectancy at baseline CD4 + T-cell count ≥350 cells/mm 3 was 51.9 (95% CI, 51.0, 52.9) years for age 20 years and 43.2 (95% CI, 42.4, 44.1) years for age 35 years, close to life expectancy in the general Thai population. Conclusions Increasing life expectancy with higher baseline CD4 + T-cell counts supports the guideline recommendations to start cART irrespective of CD4 + T-cell count. These results are beneficial to forecast the treatment cost and develop health policies for people living with HIV in Thailand and Asia.