Articles producció científica> Medicina i Cirurgia

Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe

  • Identification data

    Identifier: imarina:5130929
    Authors:
    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.
    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 he
  • Others:

    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
    Link to the original source: https://insights.ovid.com/article/00002030-201701140-00011
    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
    Article's DOI: 10.1097/QAD.0000000000001270
    Entity: Universitat Rovira i Virgili
    Journal publication year: 2017
    First page: 253
    Publication Type: Journal Publications
  • Keywords:

    Immunology,Immunology and Allergy,Infectious Diseases,Virology
    Socioeconomic factors
    Mortality
    Inequality
    Hiv
    Cohort studies
    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
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