Background:

We used integrated national data sources to estimate life expectancy in the Australian population of people living with HIV receiving antiretroviral therapy (ART).

Methods:

Probabilistic data linkage of the National HIV Registry, National Death Index and Medicare Consumers Directory was used to create a cohort of people diagnosed with HIV in Australia between 1-January-1997 and 31-December-2024.  We evaluated trends in HIV related deaths over time.

For life expectancy estimation we retained persons with recorded ART dispensing for at least a year between 2013-2025 and modelled hazard using parametric survival regression with restricted cubic splines and log of age as the underlying time scale and adjusted for year of diagnosis, CD4 cell-count at diagnosis, sex and injecting drug use mode of exposure. A period life table approach was taken with average rate ratio adjustment based on general population mortality for the open age group (80+).

Results:

27,774 HIV Registry notifications were included after linkage and clerical review with 20,239 having at least 1 year of treatment after 2013. Median age at death increased from a minimum of 37 in 2000 to 61 in 2024 (57 for non-HIV-related causes, 63 for HIV-related cause) . Life expectancy for 20 year-olds with CD4 cell count >350 was 61.4 years for females and 58.7 years for males, and for 40 year-olds was 42.4 years for females and 42.2 years for males.

Conclusion:

Increases in observed life expectancy in people living with HIV are partly attributable to increasing age of the epidemic and indicate increasing complexity of health management associated with an ageing population of people living with HIV. Trends in cause of death attributable to HIV have not diverged from those attributable to non-HIV causes, with improvements in life expectancy compared to the general population being less apparent in females living with HIV.