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[Socio-demographic factors associated with the progression of HIV infection and the impact of HAART in a seroconverter cohort in Madrid (1986-2009)].
- Source :
-
Enfermedades infecciosas y microbiologia clinica [Enferm Infecc Microbiol Clin] 2012 Mar; Vol. 30 (3), pp. 117-23. Date of Electronic Publication: 2011 Oct 19. - Publication Year :
- 2012
-
Abstract
- Background: The objective of this work is to study the impact of HAART at a population level and to identify socio-demographic factors that may affect it, which is essential for deciding interventions.<br />Methods: An open, prospective cohort of HIV seroconverters recruited in the Centro Sanitario Sandoval (1986-2009), and followed up in collaboration with referral hospitals in the Comunidad Autónoma de Madrid. Cumulative incidence of AIDS and death was calculated by the multiple decrements method, and predictive Fine & Gray models were developed to identify associated factors. A calendar period (<1997; ≥ 1997) was introduced as a proxy of HAART availability.<br />Results: A total of 479 HIV seroconverters were identified. Hazard Ratio (HR) for progression to AIDS was 0.215 (95% CI: 0.11-0.519; P<.01) for the period ≥ 1997. Risk increased with age at the time of seroconversion (for each year older HR=1.071; 95% CI: 1.038-1.105; P<.01), but only prior to 1997. In the following period, only a high educational level showed to be a protective factor (HR=0.982; 95% CI: 0.936-1.031; P=.06). HR for progression to death was 0.134 (95% CI: 0.052-0.346; P<.01) for the period after 1997, 0.383 (95% CI: 0.168-0.875; P=.02) in people with high educational level and 1.048 (95% CI: 1.014-1.084; P<.01) for each year increase in age at seroconversion, both latter effects being homogeneous throughout the two periods.<br />Conclusion: HAART has had a great impact on the risk of progression to AIDS and death, but this benefit appears to be influenced by age at HIV infection and educational level of the patient, which highlights the importance of a global approach to case management and of the implementation of policies that address social inequities in health.<br /> (Copyright © 2011 Elsevier España, S.L. All rights reserved.)
- Subjects :
- Acquired Immunodeficiency Syndrome prevention & control
Adult
Age Factors
Anti-HIV Agents therapeutic use
Disease Progression
Educational Status
Female
HIV Infections drug therapy
Humans
Incidence
Male
Models, Theoretical
Prospective Studies
Risk
Socioeconomic Factors
Spain epidemiology
Young Adult
Antiretroviral Therapy, Highly Active
HIV Infections epidemiology
HIV Seropositivity
Subjects
Details
- Language :
- Spanish; Castilian
- ISSN :
- 1578-1852
- Volume :
- 30
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Enfermedades infecciosas y microbiologia clinica
- Publication Type :
- Academic Journal
- Accession number :
- 22014512
- Full Text :
- https://doi.org/10.1016/j.eimc.2011.07.016