Project #201 : Impact of COVID-19 pandemic on life expectancy among people with HIV

Certain populations were at particularly high risk of the effects of COVID-19, including people with HIV, because of reduced immune functioning caused by HIV. People with HIV were one of the groups prioritised for COVID-19 vaccinations when these became available. A previous OpenSAFELY study from 2021 concluded that people with HIV were at increased risk of COVID-19 mortality. Prior to the COVID-19 pandemic, other studies had found declining mortality rates for people with HIV due to the increased availability of combination antiretroviral therapy for HIV, which is highly effective at reducing AIDS-related mortality. This study aims to understand whether mortality rates and life expectancies among people with HIV changed during the years of the COVID-19 pandemic, and how much of this remaining life expectancy is spent “comorbidity free” (i.e. without additional health conditions). We would like to know whether any changes differ according to subgroups defined by gender, region, and socio-economic status.

We will use coding to select the population who are known to have HIV. We will record the duration of time from the first recorded date a person has HIV until the OpenSAFELY database close date, or the date of death. We will use these durations to calculate all-cause and cause-specific mortality rates for people with HIV in the pre-COVID-19 period (2015-2019), the early COVID-19 period (2020-21), and the late COVID-19 period (2022-2024). We will do this for different age groups and enter them into life tables: a method for calculating remaining life expectancies at specific ages (e.g. aged 50 years). We will then calculate the rates that people with HIV develop other comorbidities (e.g. lung and liver disease) and use similar lifetable methods to estimate the amount of remaining life expectancy at specific ages spent without comorbidities. We will repeat these analyses, separately stratifying the subgroups of interest (e.g. by gender) to see if changes seen in the overall population of people with HIV, are the same among these subgroups.

We expect this work to benefit the public by understanding how the COVID-19 pandemic affected health inequalities. Remaining life expectancies are intuitive and often easier to understand than mortality rates. So, there is interest in these estimates from patient groups. These data are also important for policymakers to know the scope of any potential issues, and for identifying who and where to target interventions.