Universität zu Köln

del Amo, J., Lodi, S., Dray-Spira, R., Wittkop, L., Monge, S., Braun, D., Vehreschild, J., Teira, R., Campbell, C., Monforte, d'Arminio A., Zangerle, R., Ghosen, J., Kourkounti, S., Dabis, F., Leport, C., Meyer, L., Termote, M., Kirk, O., Porter, K., Spire, B., Chene, G. and Egger, M. (2017). Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe. Aids, 31 (2). S. 253 - 263. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1473-5571

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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. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code del Amo, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lodi, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dray-Spira, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittkop, L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Monge, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Braun, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Teira, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Campbell, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Monforte, d'Arminio A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zangerle, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ghosen, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kourkounti, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dabis, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Leport, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Termote, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kirk, O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Porter, K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Spire, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Chene, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Egger, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-242515
DOI:	10.1097/QAD.0000000000001270
Journal or Publication Title:	Aids
Volume:	31
Number:	2
Page Range:	S. 253 - 263
Date:	2017
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1473-5571
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INJECTING DRUG-USERS; SOCIOECONOMIC POSITION; DISEASE PROGRESSION; HEALTH INEQUALITIES; GENDER-DIFFERENCES; INFECTED PATIENTS; MORTALITY; THERAPY; DEATH; RISK Multiple languages Immunology; Infectious Diseases; Virology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24251