Gueler Aysel, Schoeni-Affolter Franziska, Moser André, Bertisch Barbara, Bucher Heiner C, Calmy Alexandra, Cavassini Matthias, Ledergerber Bruno, Wandeler Gilles, Egger Matthias
aInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern bSwiss HIV Cohort Study Data and Coordination Center, University Hospital and University of Lausanne, Lausanne cDepartment of Geriatrics, Bern University Hospital, and Spital Netz Bern Ziegler, and University of Bern, Bern dDivision of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen eBasel Institute for Clinical Epidemiology and Biostatistics fDivision of Infectious Diseases and Hospital Hygiene, University Hospital Basel, Basel gDivision of Infectious Diseases, HIV Unit, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva hDivision of Infectious Diseases, Department of Medicine, University Hospital of Lausanne, University of Lausanne, Lausanne iDivision of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich jDepartment of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland kCentre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
AIDS. 2015 Jan 14;29(2):231-8. doi: 10.1097/QAD.0000000000000524.
Inequalities and inequities in health are an important public health concern. In Switzerland, mortality in the general population varies according to the socio-economic position (SEP) of neighbourhoods. We examined the influence of neighbourhood SEP on presentation and outcomes in HIV-positive individuals in the era of combination antiretroviral therapy (cART).
The neighbourhood SEP of patients followed in the Swiss HIV Cohort Study (SHCS) 2000-2013 was obtained on the basis of 2000 census data on the 50 nearest households (education and occupation of household head, rent, mean number of persons per room). We used Cox and logistic regression models to examine the probability of late presentation, virologic response to cART, loss to follow-up and death across quintiles of neighbourhood SEP.
A total of 4489 SHCS participants were included. Presentation with advanced disease [CD4⁺ cell count <200 cells/μl or AIDS] and with AIDS was less common in neighbourhoods of higher SEP: the age and sex-adjusted odds ratio (OR) comparing the highest with the lowest quintile of SEP was 0.71 [95% confidence interval (95% CI) 0.58-0.87] and 0.59 (95% CI 0.45-0.77), respectively. An undetectable viral load at 6 months of cART was more common in the highest than in the lowest quintile (OR 1.52; 95% CI 1.14-2.04). Loss to follow-up, mortality and causes of death were not associated with neighbourhood SEP.
Late presentation was more common and virologic response to cART less common in HIV-positive individuals living in neighbourhoods of lower SEP, but in contrast to the general population, there was no clear trend for mortality.
健康方面的不平等是一个重要的公共卫生问题。在瑞士，普通人群的死亡率因社区的社会经济地位（SEP）而异。我们研究了在联合抗逆转录病毒疗法（cART）时代，社区SEP对HIV阳性个体的就诊情况和治疗结果的影响。
根据2000年瑞士HIV队列研究（SHCS）中50户最邻近家庭的普查数据（户主的教育程度和职业、租金、每间房的平均人数），获取2000 - 2013年患者的社区SEP。我们使用Cox模型和逻辑回归模型，来研究社区SEP五分位数中晚期就诊、对cART的病毒学反应、失访和死亡的概率。
共纳入4489名SHCS参与者。在SEP较高的社区，出现晚期疾病（CD4⁺细胞计数<200个/μl或艾滋病）和患艾滋病的情况较少见：将SEP最高五分位数与最低五分位数进行比较，年龄和性别调整后的优势比（OR）分别为第0.71[95%置信区间（95%CI）0.58 - 0.87]和0.59（95%CI 0.45 - 0.77）。在接受cART治疗6个月时病毒载量不可检测的情况，在最高五分位数中比最低五分位数中更常见（OR 1.52；95%CI 1.14 - 2.04）。失访、死亡率和死亡原因与社区SEP无关。
在SEP较低社区的HIV阳性个体中，晚期就诊更常见，对cART的病毒学反应更少见，但与普通人群不同的是，死亡率没有明显趋势。
