Autor segons l'article: Del Amo,J., Lodi S., Dray-Spira R., Wittkop L., Monge S., Braun D., Vehreschild J., Teira R., Campbell C., D'arminio M.A., Zangerle R., Ghosen J., Kourkounti S., Dabis F., Leport C., Meyer L., Termote M., Kirk O., Porter K., Spire B., Chene G., Egger M.
Departament: Medicina i Cirurgia
Autor/s de la URV: Vidal Marsal, Francisco
Paraules clau: Socioeconomic factors Mortality Inequality Hiv Cohort studies
Resum: BACKGROUND: Socioeconomic inequality challenges population-level implementation of health interventions. We investigated differences by educational level in clinical, virological, and immunological responses to combined antiretroviral treatment (cART) in HIV-positive men and women in Collaboration of Observational HIV Epidemiological Research in Europe, a European collaboration. METHODS: Data were pooled from 15 cohorts in eight countries of patients initiating cART in 1996-2013 with data on educational level categorized in UNESCO/ISCED classifications. Kaplan-Meier curves, Cox and piecewise linear mixed models were used. RESULTS: Of 24 069 HIV-positive patients, 9% had not completed primary education, 32% had completed primary, 44% secondary, and 15% tertiary education. Overall, 21% were women, who were overrepresented in lower educational strata. During 132 507 person-years of follow-up, 1081 individuals died; cumulative mortality decreased with higher educational level (P < 0.001). Over 122 765 person-years, new AIDS events or death occurred in 2598 individuals; differences by education were more marked than for death alone (P < 0.001). Virological response was achieved by 67% of patients without completed basic education, 85% with completed primary education, 82% with secondary, and 87% with tertiary (P < 0.001). Patients with higher education had higher CD4 cell count at cART initiation and at each time after cART but rate of CD4 cell count recovery did not differ. Differences in mortality and clinical responses were similar for men and women and were not entirely explained by delayed HIV diagnosis and late cART initiation. CONCLUSION: HIV-positive patients with lower educational level had worse responses to cART and survival in European countries with universal healthcare. To maximize the population impact of cART, Europe needs to decrease the socioeconomic divide.
Àrees temàtiques: Virology Saúde coletiva Psicología Nutrição Medicine (all) Medicina veterinaria Medicina iii Medicina ii Medicina i Interdisciplinar Infectious diseases Immunology and allergy Immunology General medicine Farmacia Educação Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Biotecnología
Accès a la llicència d'ús: https://creativecommons.org/licenses/by/3.0/es/
ISSN: 02699370
Adreça de correu electrònic de l'autor: francesc.vidal@urv.cat
Identificador de l'autor: 0000-0002-6692-6186
Pàgina final: 262
Data d'alta del registre: 2024-09-07
Volum de revista: 31
Versió de l'article dipositat: info:eu-repo/semantics/acceptedVersion
URL Document de llicència: https://repositori.urv.cat/ca/proteccio-de-dades/
Referència a l'article segons font original: Aids. 31 (2): 253-262
Referència de l'ítem segons les normes APA: Del Amo,J., Lodi S., Dray-Spira R., Wittkop L., Monge S., Braun D., Vehreschild J., Teira R., Campbell C., D'arminio M.A., Zangerle R., Ghosen J., Kou (2017). Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe. Aids, 31(2), 253-262. DOI: 10.1097/QAD.0000000000001270
Entitat: Universitat Rovira i Virgili
Any de publicació de la revista: 2017
Pàgina inicial: 253
Tipus de publicació: Journal Publications
Repositori URV