Neighbourhood socio-economic position, late presentation and outcomes in people living with HIV in Switzerland

Publication

Neighbourhood socio-economic position, late presentation and outcomes in people living with HIV in Switzerland

Journal Paper/Review - Jan 14, 2015

Gueler Aysel, Egger Matthias, Wandeler Gilles, Ledergerber Bruno, Cavassini Matthias, Calmy Alexandra, Bucher Heiner C, Bertisch Barbara, Moser André, Schoeni-Affolter Franziska, Swiss HIV Cohort Study, Swiss National Cohort

Citation

Gueler A, Egger M, Wandeler G, Ledergerber B, Cavassini M, Calmy A, Bucher H, Bertisch B, Moser A, Schoeni-Affolter F, Swiss HIV Cohort Study, Swiss National Cohort. Neighbourhood socio-economic position, late presentation and outcomes in people living with HIV in Switzerland. AIDS 2015; 29:231-8.

Type

Journal Paper/Review (English)

Journal

AIDS 2015; 29

Publication Date

Jan 14, 2015

Issn Electronic

1473-5571

Pages

231-8

Brief description/objective

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.