Aysel Gueler1, Franziska Schoeni-Affolter, André Moser, Barbara Bertisch, Heiner C Bucher, Alexandra Calmy, Matthias Cavassini, Bruno Ledergerber, Gilles Wandeler, Matthias Egger. 1. 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.
Abstract
OBJECTIVES: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVES: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Lyolya Hovhannisyan; Lara E Coelho; Luciane Velasque; Raquel B De Boni; Jesse Clark; Sandra W Cardoso; Jordan Lake; Valdilea G Veloso; Beatriz Grinsztejn; Paula M Luz Journal: AIDS Behav Date: 2021-09-25
Authors: Aysel Gueler; André Moser; Alexandra Calmy; Huldrych F Günthard; Enos Bernasconi; Hansjakob Furrer; Christoph A Fux; Manuel Battegay; Matthias Cavassini; Pietro Vernazza; Marcel Zwahlen; Matthias Egger Journal: AIDS Date: 2017-01-28 Impact factor: 4.177
Authors: Olof Elvstam; Gaetano Marrone; Patrik Medstrand; Carl Johan Treutiger; Veronica Svedhem; Magnus Gisslén; Per Björkman Journal: Open Forum Infect Dis Date: 2021-03-17 Impact factor: 3.835
Authors: Kiffer George Card; Jeremy Gibbs; Nathan John Lachowsky; Blake W Hawkins; Miranda Compton; Joshua Edward; Travis Salway; Maya K Gislason; Robert S Hogg Journal: JMIR Public Health Surveill Date: 2018-08-08