People with HIV who have less education have worse outcomes after initiation of antiretroviral therapy[ART], According to data from a large European cohort collaboration published in the online edition of the JournalAIDS. mortality and AIDS rates decreased with increasing level of education and education was also associated with viral suppression and CD4 count at the beginning of Antiretroviral Therapy.
"Marked differences in mortality and clinical response to antiretroviral therapy could not be fully explained by delayed diagnosis of HIV infection or the onset delayed antiretroviral therapy, since the differences remained even after stringent tests to those who began treatment with CD4 > 350 cells / mm3 and without previous diagnosis of AIDS, "the authors commented. "The associations we found between education and clinical outcomes are probably mediated by material means and, of course, psychosocial pathways."
Even in countries with free access to health care, the group that make up the "bottom of the social pyramid," with lower socioeconomic status is associated with worse health outcomes. The researchers of a large collaboration of several studies of HIV cohort and observational study of collaborationHIV epidemiological investigation in Europe is a consistent approach () - and has shown that late HIV diagnosis and early therapy Antiretroviral with a low CD4 counts are associated with lower levels of education.
The researchers now wanted to see if the disparities in health outcomes for education persisted after the start of Antiretroviral Therapy.
Therefore, a study was designed to examine the differences by level of education in mortality and new aid after starting Antiretroviral therapy [HAART] and also viral suppression and changes in CD4 counts.
Data 15 cohort studies in eight states were available for analysis. Adult patients starting Antiretroviral Therapy for the first stage between 1996 and 2013 were eligible for inclusion. Schooling was standardized across the cohorts.
The main outcomes were:
- All-cause mortality.
- New AIDS event or death.
- Virological suppression - two successive measurements of viral load below 400 copies / ml. (Translator's Note: It was what you might check in 2013 - today there are tests commonly used in research, able to detect higher scores only five copies of HIV RNA)
- Increased CD4 cell count during the first six years of Antiretroviral Therapy.
The results were adjusted in order to assess differences such as gender, age at onset of Antiretroviral Therapy, season in which there was the beginning of Antiretroviral therapy early (before 2001, 2001-2004, 2005-2008, 2009-2013), through infection, Antiretroviral Therapy before making measurements of viral load and / or CD4 count; viral load measurement pre-antiretroviral therapy against AIDS and type of Antiretroviral Therapy.
A total of 24,069 people were eligible for inclusion. Overall, 9% had not completed primary education; 32% had only primary education; 44% had completed secondary education and 14% had a university or equivalent education.
Individuals with an average level of education were more prominent in being male and belong to the contagion of group represented as MSM (Men who have sex with men- WARNING MARRIED WOMEN). A fifth of women were in lower education levels.
There was an association between education and mortality. During 132,507 person-years of analysis, 1081 people died. Mortality decreased with increasing educational level (p <0,001) and these differences persisted in models that previously adjusted for potential error factors. People with a university education had a lower risk of death than all other education groups. A similar pattern of mortality was found in an analysis controlling the timing of the initiation of antiretroviral therapy, the CD4 count, the beginning of the previous Antiretroviral Therapy AIDS and also the age at which treatment was initiated.
A significant association was present also between the educational level, mortality and AIDS. More than 122,765 person-years, there was 2598 new clinical manifestations or deaths. Differences in the incidence of AIDS / death by level of education were even more marked than for death alone (p <0,001).
One year after the start of HIV therapy, 77% of the patients achieved viral suppression. This was achieved by 67% of people with incomplete primary education, 85% of those with a primary education, 82% of individuals with secondary education and 87% of those who attended a university (p <0,001).
The differences in results between groups became less pronounced over time and no longer significant after ten years of therapy. After adjusting for possible error factors, those with incomplete primary education or primary school were likely to reach a lower virologic response of only twenty percent and seven percent, respectively, of the patients who participated in the college.
Returning to immunological results, the data showed that the higher the level of education attained, the more CD4 count at the start of ART. However, there was no evidence that the level of education was associated with recovery of CD4 count six months after initiation of therapy.
"Patients HIV positive on antiretroviral combination therapy who had less education had higher mortality, higher rates of clinical events, and worse than patients with better responses to care, with respect to viral load had more education, write the authors. "We see such health differentials for a period of eighteen in eight European countries where access to health care and antiretroviral therapy is universal."
Translated by Claudio Original Souza- in English Educational attainment associated with health outcomes after starting HIV therapy written by Michael Carter and originally published in AIDSMAP.COMin 11 2016 October. Reviewed by Mara Macedo.