Uniform risk of clinical progression despite differences in utilization of highly active antiretroviral therapy: Swiss HIV Cohort Study

Abstract

HIV-infected injecting drug users and those with lower levels of educational attainment start HAART later than other patient groups. The deferred initiation of therapy in these patients does not, however, appear to translate into an increased risk of clinical disease progression. This observation has important implications for treatment policy and the design of future clinical trials.

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

“…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.…”

“…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.…”

“…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.…”

Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine

“…In both Switzerland and the United States of America, people with lower educational attainment or socioeconomic status have been found to be relatively less likely to initiate cART. 21,22 However, among treated individuals, data on the association between educational attainment and the progression of HIV disease are conflicting, 21,23 probably because context-specific factors (e.g. adherence support) may mitigate the health-related sequelae of social deprivation.…”

Pilot Study to Enhance HIV Care Using Needle Exchange-Based Health Services for Out-of-Treatment Injecting Drug Users

“…While other studies have demonstrated the negative effect of alcohol 24 and illicit drugs on access to and adherence with ART, [25][26][27][28][29][30][31][32][33] this small pilot study suggests that gaining access to ART in a trusted setting may promote positive health behaviors (e.g., seeking and gaining access to drug treatment) and result in improved health outcomes among active drug users. In our study, the proportion of individuals who achieved an HIV-1 RNA level below the level of detection and an increase of the CD4 lymphocytes count is similar to results obtained in clinical trials in highly selected non-IDU patients.…”