Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe (1996-2013): a collaborative cohort study. AIDS
Del Amo et al. on behalf of COHERE in Euro-Coord aimed to investigate differences by educational level in virological and immunological response to combined antiretroviral treatment (cART), as well as incidence of all-cause mortality and new AIDS-defining events in HIV-positive men and women in COHERE data from 1996 to 2013.
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, 1’081 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.
In conclusion, the study-results support the argument for sustained educational efforts at the European level to improve active citizenship, social cohesion, and health impacting on the macro-level determinants. They also reinforce the need for proximal down-stream interventions on clinical and preventive care among less educated HIV-positive patients once they are linked to care to address inequities.