Lodi Sara, Dray-Spira Rosemary, Touloumi Giota, Braun Dominique, Teira Ramon, D'Arminio Monforte Antonella, Gallois Anne, Zangerle Robert, Spire Bruno, Dabis Francois, Stähelin Cornelia, Termote Monique, Kirk Ole, Chêne Genevieve, Egger Matthias, del Amo Julia
AIDS. 2014 Sep 24;28(15):2297-306. doi: 10.1097/QAD.0000000000000410.
In Europe and elsewhere, health inequalities among HIV-positive individuals are of concern. We investigated late HIV diagnosis and late initiation of combination antiretroviral therapy (cART) by educational level, a proxy of socioeconomic position.
We used data from nine HIV cohorts within COHERE in Austria, France, Greece, Italy, Spain and Switzerland, collecting data on level of education in categories of the UNESCO/International Standard Classification of Education standard classification: non-completed basic, basic, secondary and tertiary education. We included individuals diagnosed with HIV between 1996 and 2011, aged at least 16 years, with known educational level and at least one CD4 cell count within 6 months of HIV diagnosis. We examined trends by education level in presentation with advanced HIV disease (AHD) (CD4 <200 cells/μl or AIDS within 6 months) using logistic regression, and distribution of CD4 cell count at cART initiation overall and among presenters without AHD using median regression.
Among 15 414 individuals, 52, 45,37, and 31% with uncompleted basic, basic, secondary and tertiary education, respectively, presented with AHD (P trend <0.001). Compared to patients with tertiary education, adjusted odds ratios of AHD were 1.72 (95% confidence interval 1.48-2.00) for uncompleted basic, 1.39 (1.24-1.56) for basic and 1.20 (1.08-1.34) for secondary education (P < 0.001). In unadjusted and adjusted analyses, median CD4 cell count at cART initiation was lower with poorer educational level.
Socioeconomic inequalities in delayed HIV diagnosis and initiation of cART are present in European countries with universal healthcare systems and individuals with lower educational level do not equally benefit from timely cART initiation.
在欧洲及其他地区，HIV阳性个体之间的健康不平等问题备受关注。我们以教育程度作为社会经济地位的替代指标，调查了HIV诊断延迟及联合抗逆转录病毒疗法（cART）启动延迟的情况。
我们使用了奥地利、法国、希腊、意大利、西班牙和瑞士COHERE研究中9个HIV队列的数据，收集了联合国教科文组织/国际教育标准分类标准类别下的教育程度数据：未完成基础教育、基础教育、中等教育和高等教育。我们纳入了1996年至2011年间诊断为HIV的个体，年龄至少16岁，已知教育程度且在HIV诊断后6个月内至少有一次CD4细胞计数。我们使用逻辑回归分析了不同教育程度的个体出现晚期HIV疾病（AHD）（CD4<200个细胞/μl或6个月内患艾滋病）的趋势，并使用中位数回归分析了cART启动时总体及无AHD的患者中CD4细胞计数的分布情况。
在15414名个体中，未完成基础教育、基础教育、中等教育和高等教育的个体分别有52%、45%、37%和31%出现AHD（P趋势<0.001）。与高等教育患者相比，未完成基础教育的个体AHD调整后的比值比为1.72（95%置信区间1.48 - 2.00），基础教育为1.39（1.24 - 1.56），中等教育为1.20（1.08 - 1.34）（P<0.001）。在未调整和调整分析中，cART启动时CD4细胞计数的中位数随着教育程度降低而降低。
在拥有全民医疗保健系统的欧洲国家，HIV诊断延迟及cART启动存在社会经济不平等，教育程度较低的个体未能同样从及时启动cART中受益。
