Determinants of Virological Response to Antiretroviral Therapy: Socio-Economic Status Still Plays a Role in the Era of cART. Results from the ANRS-VESPA 2 Study, France

d’Almeida, Kayigan Wilson; Spire, Bruno; Dray‐Spira, Rosemary

doi:10.3851/imp3064

Cited by 13 publications

(22 citation statements)

References 51 publications

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“…In addition, the relationship between occupational status and ART access and outcomes was also analyzed. Very few studies [ 12 , 27 ] have addressed this point to date, as this information is not registered in the most part of the cohorts enrolling HIV patients. In France [ 27 ], a global indicator of social vulnerability including education, employment, and housing stability and comfort, after adjustment for lifestyle factors, psychosocial characteristics (depression, drug using) and known biomedical factors, was associated with mortality in PLHIV.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, unemployment was associated with a reduced sustained virological suppression (e.g. undetectable viral load for ≥6 months) [ 12 ]. In our analysis, unemployment was associated with all three endpoints (a longer time to ART initiation, lower chances to reach a suppressed HIV viremia, and higher risk of discontinuation).…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study from the ICONA (Italian Cohort Naïve Antiretrovirals) cohort, among socio-demographic factors, migrant status was already demonstrated to be associated with barriers to ART initiation and with increased risk of treatment failure compared to natives [ 7 ]. However, other social or behavioral determinants, including gender [ 8 , 9 ], poor education [ 10 , 11 ], unemployment [ 12 ], social exclusion within special population groups, e.g. people who inject drugs (PWID), need to be considered [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

et al. 2018

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BackgroundSocial determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy.MethodsAll ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test.ResultsA total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29–44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1–3.7), with a significant decrease over time [2002–2006 = 3.3 yrs. (0.2–9.4); 2007–2011 = 1.0 yrs. (0.1–3.9); 2012–2016 = 0.2 yrs. (0.1–2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation.ConclusionsDespite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

et al. 2018

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“…This score is reliable when compared to the Townsend and the Carstairs indices and has been identified as an independent determinant of worse health status and premature mortality [10]. In different previous French studies, 58% of HIV-infected adults were classified as deprived using the EPICES score [11], 49% reported financial difficulties [12], 30% reported material deprivation [13]. The impressive level of deprivation in our study with nearly three over four participants classified as deprived using the EPICES score could be linked to the location of hospitals in two suburbs near Paris.…”

Section: Discussionmentioning

confidence: 99%

Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France

et al. 2019

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Barriers to achieve sustained HIV virological suppression on antiretroviral therapy (ART) jeopardize the success of the 90:90:90 UNAIDS initiative which aims to end the HIV/AIDS epidemic. In France, where access to ART is free and universally available, we analyze the way in which social determinants of health (i.e. cultural, environmental) and economic factors might influence virological outcomes. A cross-sectional study was performed in two hospitals located in Paris area. All consecutive people living with HIV (PLHIV) on ART for at least 6 months attending the outpatient clinics between 01/05/2013 and 31/10/2014 answered an individual score of deprivation, EPICES, retrieving information on health insurance status, economic status, family support and leisure activity. This score varies from 0 to 100 with deprivation state defined above 30.17. Factors associated with HIV viral load >50 copies/ml were assessed by logistic regression modeling with a backward stepwise selection to select the final multivariable model. Sensitivity analyses were performed using two other thresholds for virological non-suppression (100 or 200 copies/ml). Overall, 475 PLHIV were included (53% male, median age 47 years, 66% not born in France mainly in a sub-Saharan African country). Half of French natives and 85% of migrants were classified as deprived. Median duration on ART was 9.7 years with virological suppression in 95.2% of non-deprived participants and in 83.5% of deprived ones (p = 0.001). The final multivariable model retained ART tiredness, younger age, a previous AIDS event and social deprivation (adjusted Odds Ratio, 2.9; 95%CI, 1.2–7.0) as determinants of virological non-suppression but not migration in itself. When using separate components of EPICES score, reporting economic difficulties and non-homeownership were associated with virological non-suppression. In addition to interventions focusing on cultural aspects of migration, social interventions are needed to help people with social vulnerability to obtain sustained responses on ART.

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“…[11][12][13][14] These same characteristics and others such as lack of health insurance, lower levels of educational attainment, and low CD4 count before starting ART have been identified as predictors of virologic failure. [15][16][17][18] Limited data have been published on the clinical outcomes of HIV-infected undocumented immigrants. One study from a single HIV clinic in Texas that examined outcomes 1 year after entry into care found that undocumented Hispanics achieved rates of retention in care and viral suppression that were similar to other groups of patients.…”

Section: Introductionmentioning

confidence: 99%

Outcomes Along the HIV Care Continuum Among Undocumented Immigrants in Clinical Care

Ross

Felsen

Cunningham

et al. 2017

AIDS Research and Human Retroviruses

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HIV-infected undocumented immigrants face unique barriers to care yet little is known about their clinical outcomes. We performed a retrospective cohort study of HIV-infected adults in clinical care from 2006 to 2014 at a large academic medical center in a setting where medical insurance is available to HIV-infected undocumented immigrants. Undocumented status was assessed based on Social Security number and insurance status and verified through medical chart review. Using Poisson regression models, we compared undocumented and documented patients with respect to retention in care (≥2 HIV-related laboratory tests ≥90 days apart), antiretroviral therapy (ART) prescription (≥3 active antiretroviral agents prescribed in a year), and viral suppression (HIV RNA <200 copies/ml for the last measured viral load) for each year in care. Of 7,551 patients included in the analysis, we classified 173 (2.3%) as undocumented. For each year of the analysis, higher proportions of undocumented patients were retained in care, prescribed ART, and virally suppressed. In adjusted models, undocumented status was associated with increased probability of retention in care [risk ratio (RR) 1.05, confidence interval (95% CI) 1.01-1.09], ART prescription (RR 1.05, 95% CI 1.01-1.08), and viral suppression (RR 1.13, 95% CI 1.08-1.19) compared to documented status. Undocumented patients achieved clinical outcomes at modestly higher rates than documented patients, despite entering care with more advanced disease. In a setting where insurance is available to undocumented patients, similar outcomes along the HIV care continuum may be achieved regardless of immigration status.

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Determinants of Virological Response to Antiretroviral Therapy: Socio-Economic Status Still Plays a Role in the Era of cART. Results from the ANRS-VESPA 2 Study, France

Abstract: Structural social factors remain strong determinants of treatment response and should be addressed in a broad approach of care, but wider political issues should also be investigated.

Cited by 13 publications

References 51 publications

Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France

Outcomes Along the HIV Care Continuum Among Undocumented Immigrants in Clinical Care

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