Objectives : To estimate life expectancy (LE) over 25 years in HIV-positive people and compare their LE with recent estimates for the general population, by education.

Methods : Patients aged 20 years or older enrolled in the Swiss HIV Cohort Study 1988-2013 were eligible. Patients alive in 2001 were matched to up to 100 Swiss residents, by sex, year of birth, and education. LE at age 20 was estimated for monotherapy (1988-1991), dual therapy (1992-1995), early combination antiretroviral therapy (cART, 1996-1998), later cART (1999-2005) and recent cART (2006-2013) eras. Parametric survival regression was used to model life expectancy.

Results : 16,532 HIV-positive patients and 927,583 residents were included. Characteristics of HIV-positive patients were : 11,916 (72.1%) were men, 11,304 (68.4%) were treatment-naïve at enrolment, and 4,707 (28.5%) had a history of current or past IDU. Median follow-up was 6.30 years (IQR 2.5-13.0 years), median age was 35 years (IQR 29-42 years), and the median CD4 cell count at enrolment was 332 cells/mm 3 (IQR 167-536). LE at age 20 of HIV-positive individuals increased from 11.8 years (95% CI 11.2-12.5) in the monotherapy era to 54.9 years (95% CI 51.2-59.6) in the most recent cART era. Differences in LE across educational levels emerged with cART. In the most recent cART period, LE at age 20 years was 52.7 years (95% CI 46.4-60.1) with compulsory education, compared to 60.0 years (53.4-67.8) with higher education. Estimates for the general population were 61.5 years and 65.6 years, respectively. In the most recent cART period, HIV-positive people continued to have an estimated LE that was lower than their peers from the general population. It was 91.5% (95% CI 84.6%-98.4%) of the matched general population for patients with higher education, 84.5% (95% CI 78.8%-90.3%) for patients with vocational training and 85.6% (95% CI 76.7%-94.6%) for patients with compulsory education. LE in highly educated patients was similar to the LE of individuals from the general population with compulsory education only. Male sex, smoking, injection drug use and low CD4 counts at enrolment were also independently associated with mortality in HIV patients.

Conclusion : In Switzerland, educational inequalities in LE were larger among HIV-infected persons than in the general population. Highly educated HIV-positive people have an estimated LE similar to Swiss residents with compulsory education. Earlier start of cART and effective smoking cessation programs could improve HIV-positive LE further and reduce inequalities.