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

del Amo, J; Lodi, S; Dray-Spira, R; Wittkop, L; Monge, S; Braun, D; Vehreschild, J; ... Egger, M; + view all (2017) Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe. AIDS , 31 (2) pp. 253-262. 10.1097/QAD.0000000000001270. Green open access

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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. CONCLUSIONS: 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.

Type: Article
Title: Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001270
Publisher version: http://dx.doi.org/10.1097/QAD.0000000000001270
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, Virology, Cohort Studies, Hiv, Inequality, Mortality, Socioeconomic Factors, Injecting Drug-Users, Socioeconomic Position, Disease Progression, Infected Patients, Health Inequalities, Gender-Differences, Missing Data, Mortality, Therapy, Cohort
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/1550615
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