Autor según el artículo: 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.
Departamento: Medicina i Cirurgia
Autor/es de la URV: Vidal Marsal, Francisco
Palabras clave: Socioeconomic factors Mortality Inequality Hiv Cohort studies
Resumen: 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.
Áreas temáticas: 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
Acceso a la licencia de uso: https://creativecommons.org/licenses/by/3.0/es/
ISSN: 02699370
Direcció de correo del autor: francesc.vidal@urv.cat
Identificador del autor: 0000-0002-6692-6186
Página final: 262
Fecha de alta del registro: 2024-09-07
Volumen de revista: 31
Versión del articulo depositado: info:eu-repo/semantics/acceptedVersion
URL Documento de licencia: https://repositori.urv.cat/ca/proteccio-de-dades/
Referencia al articulo segun fuente origial: Aids. 31 (2): 253-262
Referencia 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
Entidad: Universitat Rovira i Virgili
Año de publicación de la revista: 2017
Página inicial: 253
Tipo de publicación: Journal Publications
Repositori URV