Research in context
Evidence before this study
Large cohort studies from Europe, the USA, and Canada (including the Antiretroviral Therapy [ART] Cohort Collaboration and the North American AIDS Cohort Collaboration on Research and Design) have shown significant increases in life expectancy and decreases in mortality for people living with HIV who begin treatment with ART. Studies of life expectancy among people with HIV in low-income and middle-income countries are limited to single-country analyses (namely from South Africa and Brazil). We searched PubMed from database inception to Oct 19, 2020, for publications in English, using the search terms “life expectancy”, “Latin America”, “HIV”, “ART”, and “sex”. We found no multisite or large studies describing life expectancy changes among people with HIV who began treatment with ART in Latin America.
Added value of this study
To our knowledge, this is the largest study to examine life expectancy changes in people with HIV beginning treatment with ART in Latin America and the Caribbean over time. There were significant increases in life expectancy at age 20 years in people with HIV from 2003–08 to 2013–17, with life expectancy in the 2013–17 era estimated to be within 10 years of that of the general populations of these countries. Disparities in life expectancy among people with HIV remain, however, including differences by sex or sexual HIV transmission risk factors, level of education, history of tuberculosis, and CD4 cell count at time of ART initiation.
Implications of all the available evidence
This study shows significant improvement in life expectancy among people with HIV in the socioeconomically, culturally, and geographically diverse region of Latin America and the Caribbean since the beginning of the treat-all era. Our findings show that ART can narrow the gap in life expectancy for people with HIV in low-income and middle-income regions.