Author, as appears in the 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.
Department: Medicina i Cirurgia
URV's Author/s: Vidal Marsal, Francisco
Keywords: Socioeconomic factors Mortality Inequality Hiv Cohort studies
Abstract: 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.
Thematic Areas: 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
licence for use: https://creativecommons.org/licenses/by/3.0/es/
ISSN: 02699370
Author's mail: francesc.vidal@urv.cat
Author identifier: 0000-0002-6692-6186
Last page: 262
Record's date: 2024-09-07
Journal volume: 31
Papper version: info:eu-repo/semantics/acceptedVersion
Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
Papper original source: Aids. 31 (2): 253-262
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
Entity: Universitat Rovira i Virgili
Journal publication year: 2017
First page: 253
Publication Type: Journal Publications
Repositori URV