Effective antiretroviral therapy has led to improved survival for people with HIV, with the life expectancy of treated patients in the United States and Canada now approaching that of the general population. With this normalization of life expectancy has come an increase in occurrences of age-related comorbidities, including cardiovascular disease, cancer, liver disease, and renal disease, among people with HIV. The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) receives federal funding, as part of the American Recovery and Reinvestment Act of 2009, to validate occurrences of myocardial infarctions, cancers, end-stage renal disease, and end-stage liver disease among adults with HIV in NA-ACCORD contributing cohorts from 2000 to 2010. Since 2010, the NA-ACCORD has continued to validate myocardial infarctions, cancers, and end-stage liver disease among participants.
To learn more about the validation process, please see the following publications:
Myocardial infarction (the NA-ACCORD used the same validation process as the Center for AIDS Research Network of Integrated Clinical Systems (CNICS): Crane HM, et al. Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts. American Journal of Epidemiology 2014;179(98):996-1005.
Cancer: Silverberg MJ, et al. Cumulative incidence of cancer among HIV-infected individuals in North America. Annals of Internal Medicine 2015;163(7):507-18.
End-stage liver disease and end-stage renal disease: Kitahata M et al. Ascertainment and verification of end-stage renal and liver disease in the North American AIDS Cohort Collaboration on Research and Design. AIDS Research and Therapy 2015; 2015:923194.Number of participating cohorts and calendar years of validation, by condition.
Standardized incidence ratio
Median age at diagnosis
Cumulative incidence by viral load and CD4 count
Cumulative incidence by eGFR and HIV status
Incidence of HTN, DM, CKD
Cumulative incidence of HTN, DM, CKD
Prevalence by calendar year
Prevalence by age
Co-occurrence of most common conditions
Aging with HIV
Dashed vertical lines indicate median ages: 43 years in 2000, 48 years in 2010, 53 years in 2018.
Observed and expected life expectancy
Observed (solid lines) life expectancy from the North American AIDS Cohort Collaboration on Research and Design (United States and Canada, 2004–2015) and expected (dashed lines) life expectancy from the Lives Saved Simulation model, after a 20% reduction in drug- and alcohol-related deaths, as well as the proportion of drug- and alcohol-related deaths (bars) among key populations and their comparison groups, including black (purple) compared with white (gray) men who have sex with men (A), black (orange) compared with white (gray) women (B), Hispanic (teal) compared with non-Hispanic (gray) adults (C), and people who have a history of injection drug use (yellow) compared with those who do not (gray) (D). Expected life expectancy after a 20% reduction in drug- and alcohol-related deaths was estimated as the median estimate from 100 simulations using the Lives Saved Simulation model. From Althoff et al Am J Epidemiol 2019.