BC-CfE study shows growing gap in life expectancy between men and women with HIV

A study from the B.C. Centre for Excellence in HIV/AIDS (BC-CfE) has found a growing gap in life expectancy between men and women with living with HIV in B.C.

Life expectancy for all people living with HIV in B.C. has increased substantially since 1996, when B.C.’s health care system began providing free, highly effective antiretroviral therapy to all British Columbians with HIV. However, a study published in The Lancet Public Health found that this increase is notably smaller for women with HIV, than men. 

COAST cohort provides valuable data on HIV health outcomes

Dr. Katherine Kooij, lead author of the study, is a postdoctoral fellow with the BC-CfE, Canada’s largest HIV/AIDS research, treatment and education facility, located at St. Paul’s Hospital. Originally from the Netherlands, she came to Canada to pursue research focused on health outcomes of people with HIV, and the intersection of the HIV epidemic and the toxic drug crisis. Dr. Kooij works with BC-CfE Senior Research Fellow, Dr. Robert Hogg, on the Comparative Outcomes and Service Utilization Trends (COAST) study. 

COAST is an ongoing population-based cohort study designed to evaluate health outcomes among people living with HIV as they age. It contains linked clinical, demographic and administrative data from 1996 to 2020 of all people living with HIV in B.C., and a random sample of the general population. This data is collected through the BC-CfE Drug Treatment Program, which centrally manages antiretroviral therapy treatment across the province, and Population Data B.C., a provincial repository of longitudinal data for B.C. residents. 

Life expectancy has increased overall, but gap between men and women has grown

Dr. Kooij and the study team utilized this data to investigate trends in life expectancy for men and women with HIV in B.C. Life expectancy, the number years a person of a certain age is expected to live if mortality rates remain consistent, was calculated at ages 20, 40 and 55.

“We found that over the last twenty-five years, approximately, life expectancy has increased significantly for people with HIV, due to the availability of effective antiretroviral treatments, and public health efforts to test, treat, and keep people with HIV on treatment in B.C.,” says Dr. Kooij. 

However, the researchers found that life expectancy for women with HIV did not grow as much as it did for men.

While the total life expectancy for a 20-year-old man with HIV rose from 44 years to 68 years, the life expectancy for a woman with HIV of the same age rose to only 61 years. This gap persisted across the documented ages.

“That’s concerning, especially since women typically are expected to live longer than men,” says Dr. Kooij. 

These results were unexpected. While it was known that there was an existing gender gap in life expectancy for people with HIV, Dr. Kooij and the research team had anticipated that it would diminish over time. Instead, the study results indicate that this gap is increasing, growing from 2.33 years to 7.05 years since 1996. 

Societal, structural factors likely contribute to gap

Dr. Kooij and the research team theorize that this gap is not primarily cause by HIV itself, but by societal factors that affect the health of women more negatively than men, such as access to health care, substance use, and housing insecurity. 

“Our results show that life expectancy among people living with HIV in B.C. has increased markedly. Today, a man newly diagnosed with HIV at age twenty can expect to reach sixty-eight years old, and this is likely an underestimate, given that current treatment strategies are markedly safer and more effective than those available even a decade ago,” says Dr. Julio Montaner, BC-CfE Executive Director and Physician-in-Chief. “Life expectancy among women living with HIV in B.C. lags behind that of men. However, this is largely attributable to sociodemographic differences.”

Women in the study population were more likely to reside in less affluent neighborhoods, such as Vancouver’s Downtown Eastside, than men, were more likely to report injection drug use as an HIV transmission risk factor, and more often met the definition for substance use disorder. These are all factors that could be contributing to this gap in life expectancy. 

The researchers additionally found that women with HIV were at a 33% higher risk of death from non-communicable diseases, such as kidney, liver and lung disease, even after considering differences in age, socioeconomic status, and historic HIV-related immunodeficiency.

“One of the action points to improve the health of women with HIV could be to improve screening for noncommunicable diseases,” says Dr. Kooij.

The next steps in this research will be to further investigate the factors contributing to this gap, including looking at individual causes of death and differences in disease burden between men and women with HIV. Developing a better understanding of this gap will enable better supports and programs to be provided to further improve life expectancy among all people living with HIV.