title: Socioeconomic status, access to triple therapy, and survival from HIV-disease since 1996.
abstract: BACKGROUND
  In the era before highly active antiretroviral therapy (HAART), socioeconomic status was associated with survival from HIV disease. We have explored socioeconomic status, access to triple therapy (HAART), and mortality in the context of a universal healthcare system.
  
  
  METHODS
  We evaluated 1408 individuals who initiated double or triple therapy between 1 August 1996 and 31 December 1999, and were followed until 31 March 2000. Cumulative HIV-related mortality rates were estimated using Kaplan-Meier methods and Cox proportional hazards regression.
  
  
  RESULTS
  In the overall Cox model, we found that adherence [risk ratio (RR) 0.83; per 10% increase], CD4 cell count (RR 1.53; per 100 cell decrease), and lower socioeconomic status (RR 2.19; high versus low), were associated with HIV-related mortality. However, socioeconomic status was not significant among patients prescribed triple therapy in a stratified analysis, or in a sub-analysis restricted to patients prescribed HAART in the initial regimen. When we investigated if inequitable access to HAART by socio-economic status could explain the discrepancy, we found that persons in the lower socio-economic strata were less likely to be prescribed triple therapy even after adjustment for clinical characteristics.
  
  
  CONCLUSIONS
  In a universal healthcare system, socioeconomic status was strongly associated with HIV-related mortality. When we investigated possible explanations for this association, we found that individuals of lower socioeconomic status were less likely to receive triple therapy after adjustment for clinical characteristics. Our findings highlight the need for the monitoring of therapeutic guidelines to ensure equitable access, as treatment strategies are updated.
authors.affiliation: Population Health, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Keith
authors.initials: K
authors.lastname: Chan
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
authors.forename: Martin T
authors.initials: MT
authors.lastname: Schechter
authors.forename: David
authors.initials: D
authors.lastname: Bangsberg
authors.forename: Michael V
authors.initials: MV
authors.lastname: O'Shaughnessy
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012471:Salivary Proteins and Peptides; D012923:Social Class
chemical_list: D012471:Salivary Proteins and Peptides