Effect of education on overall and cause-specific mortality in injecting drug users, according to HIV and introduction of HAART

Abstract

Independently of HIV status, lower education predicts a higher risk of death in IDUs and its impact is stronger after 1997. Education has a protective effect on most causes of death and it cannot be entirely attributable to the access or use of HAART.

The influence of the patients’ educational levels on socioeconomic, clinical, immunological and virological endpoints

“…Similarly to some of these studies (Borrell et al, 2006;Jarrin et al, 2007;Saraceni et al, 2005) we found an inverse relationship between mortality and educational level, with differences so marked as a two-fold higher mortality in patients with none or basic education than in those with university degrees. However, these differences were not statistical significant, which may be attributed to the reduced number of adverse clinical outcomes observed in our series, clearly related to a relatively short follow-up period for patients receiving HAART.…”

“…Limitations to our study include a relatively short follow-up period for evaluating clinical outcomes, although the results we found after one year of follow-up fully agreed with those of other studies (Borrell et al, 2006;Jarrin et al, 2007;Saraceni et al, 2005). On the other hand, other newer, potent antiretroviral regimens might obtain better clinical or viroimmunological outcomes.…”

“…Few studies in the HAART era have analysed clinical progression or death in different educational levels (Borrell et al, 2006;Jarrin et al, 2007;Junghans et al, 1999;Saraceni et al, 2005). In addition to the reduced number of these reports, their design, methodology, setting, source of data, population evaluated, educational groups and parameters analysed were different, limiting furthermore the drawing of definitive conclusions.…”

“…However, these differences were not statistical significant, which may be attributed to the reduced number of adverse clinical outcomes observed in our series, clearly related to a relatively short follow-up period for patients receiving HAART. These different outcomes could also be ascribed to unequal access to HAART or medical care in patients with different socioeconomic development (Borrell et al, 2006;Dray-Spira & Lert, 2003;Jarrin et al, 2007;McFarland et al, 2003;Rapiti et al, 2000). However, some authors did not find different outcomes despite unequal access to care (Junghans et al, 1999), and our study suggests that the poorer outcomes of patients with lower educational levels were due to factors other than access to medical care and therapy, as all patients were attending specialised clinics and were receiving HAART at no cost.…”

“…Moreover, most of these studies analysed data or were carried out before the introduction or generalization of HAART (del Amo et al, 2002;Katz et al, 1998;Piketty et al, 1999;Schechter et al, 1994), evaluated socioeconomic aspects different from education (Antunes, Waldman & Borrell, 2005;Katz et al, 1998;McFarland et al, 2003;Piketty et al, 1999;Rapiti et al, 2000;Wallace, 2003;Wood et al, 2002), focused on specific populations such as IDU (Jarrin et al, 2007;Piketty et al, 1999) or homosexual men (Schechter et al, 1994), studied only specific aspects such as adherence to HAART (Gordillo et al, 1999;Nemes, Carvalho & Souza, 2004) or concentrated on the different access to HAART in diverse socioeconomic categories (Junghans et al, 1999;McFarland et al, 2003). Finally, the studies conducted in the HAART era did not disclose which patients were receiving or not HAART or the antiretroviral regimens used (Borrell et al, 2006;Caro-Murillo et al, 2007;Jarrin et al, 2007;Junghans et al, 1999;Saraceni et al, 2005). Consequently, it is surprising the lack of reliable data regarding the possible influence of educational levels on diverse outcomes of HIV infection in patients receiving HAART.…”