Life Expectancy 6.3 Years Shorter for Black MSM With HIV

Marcia Frellick

October 24, 2022

WASHINGTON, DC — The life expectancy of non-Hispanic Black men who have sex with men (MSM) and are infected with HIV lags their White counterparts by 6.3 years under standard HIV care, new data from simulation modeling suggest.

Lead author Katherine Rich, MPH, a student at Harvard Medical School in Boston, Massachusetts, presented the data October 20 at IDWeek 2022.

"Substantial disparities in care exist between Black and White MSM here in the United States," she said. "The 2030 goals of the EHE [Ending the HIV Epidemic in the US initiative] won't be met until HIV-related disparities are reduced."

Using modeling, the team was able to measure both the gaps and the potential of interventions to address those gaps.

  • The team found that improving engagement in care had the largest benefit in narrowing the gap. Improving engagement and retention in care, they write, would result in a gain of 1.4 life-years for Black MSM and 1 year for White MSM.

  • Annual testing would add 0.6 life-years for Black MSM and 0.3 life-years for White MSM compared with standard care.

  • In simulating viral suppression, the model-predicted gain would be 1.1 years for Black MSM; 0.3 for White.

Furthermore, a combination of annual testing, 95% engagement in care, and 95% virologic suppression would add 3.4 years for Black MSM (more than double the increase in life-years for any one intervention) and 1.6 years for their White counterparts, the research suggests.

The researchers projected life expectancy from age 15 to be 52.2 years for Black MSM (or 67.2 years old) and 58.5 years from age 15 for White MSM (or 73.5 years old), a difference of 6.3 years.

Kathleen McManus, MD, assistant professor of medicine in infectious diseases and international health at the University of Virginia in Charlottesville, told Medscape Medical News the projected gap in years of life should be a call to action. McManus was not involved with the study.

Life Expectancy Gap "Alarming"

"It is alarming that with current usual HIV care Black MSM with HIV have 6.3 fewer years of life expectancy than White MSM," she said. "Black MSM having lower retention in care and a lower rate of viral suppression than White MSM demonstrates that there is a problem with our current healthcare delivery to Black MSM."

With qualitative, community-engaged research, she said, "we need to ask the Black MSM community what care innovations they need, and then we need clinics and organizations to make the identified changes."

Researchers used the validated CEPAC (Cost-Effectiveness of Preventing AIDS Complications) microsimulation HIV model to project life expectancy. Using data from the US Centers for Disease Control and Prevention, they estimated the average age at HIV infection to be 26.8 years for Black MSM and 35 years for White MSM.

They estimated the proportion of time that MSM with diagnosed HIV are retained in care to be 75.2% for Black MSM and 80.6% for White MSM. They calculated the proportion who achieve virologic suppression to be 82% for Black MSM and 91.2% for White MSM.

Senior author Emily P. Hyle, MD, associate professor of medicine at Harvard and infectious diseases physician at Massachusetts General Hospital, said in a press conference before the presentation that strategies to narrow the gap will look different by region.

"Our study highlights that if you can find effective interventions, the effect can be incredibly large. These are very large differences in life-years and life expectancies," she said.

Rich gave an example of promising interventions by pointing to work by study coauthor Aima Ahonkhai, MD, MPH, assistant professor of medicine at Vanderbilt University in Nashville, Tennessee, who has received federal funding to pursue research on whether preventive care outreach in barbershops can improve prevention for Black men with HIV.

Rich noted the modeling has limitations in that it focused on health outcomes and did not simulate transmissions. Results also reflect national data and not local HIV care continuums which, she acknowledged, differ substantially.

McManus and the study authors have reported no relevant financial relationships.

IDWeek 2022. Abstract #798. Presented October 20, 2022.

Marcia Frellick is a freelance journalist based in Chicago. She has written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, Cincinnati Enquirer, and St. Cloud (Minnesota) Times. Follow her on Twitter: @mfrellick

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