title: Educational level and HIV disease progression before and after the introduction of HAART: a cohort study in 989 HIV seroconverters in Spain.
abstract: OBJECTIVE
  To analyse the effect of educational level on the progression from HIV seroconversion to highly active antiretroviral therapy (HAART) requirement, HAART initiation, AIDS and death from any cause at different periods of the HIV epidemic in Spain.
  
  
  METHODS
  Open, prospective, multicentre cohort of HIV seroconverters set up in 1983. The risk of progression was calculated by the multiple decrements method. Effect of educational level was estimated by Fine and Gray model, adjusting for sex, HIV transmission category, age and method to estimate seroconversion. Calendar period was introduced as a variable that could change over time (<1997; 1997-2003; >2003).
  
  
  RESULTS
  Up to 2009, 989 HIV seroconverters with information on educational level were identified. Some 52% and 48% had a low and a high educational level respectively. Persons with higher education had 32% lower risk of death (HR: 0.68; 95% CI 0.45 to 1.03). Regarding progression to AIDS, educational level had no effect in the pre-HAART era (HR: 1.47; 95% CI 0.91 to 2.38), but did show an effect in the period 1997-2003 (HR: 0.58; 95% CI 0.34 to 0.99), which was accentuated after 2004 (HR: 0.26; 95% CI 0.10 to 0.68). No difference was found in time to HAART requirement or initiation.
  
  
  CONCLUSIONS
  Results suggest that, despite similar access to HAART, persons with low educational level are at increased risk of HIV disease progression, highlighting the impact of social inequities on health. The availability of more effective treatments over time will strengthen the protective effect of higher education on the development of AIDS.
authors.affiliation: National Center of Epidemiology (Pab11), Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, Madrid 28029, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Monge
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Jarrín
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ferreros
authors.forename: Patricia
authors.initials: P
authors.lastname: García-Olalla
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Jorge
authors.initials: J
authors.lastname: Del Romero
authors.forename: Josefina
authors.initials: J
authors.lastname: Belda
authors.forename: Jesús
authors.initials: J
authors.lastname: Castilla
authors.forename: Francisco
authors.initials: F
authors.lastname: Bolúmar
authors.forename: Julia
authors.initials: J
authors.lastname: Del Amo
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents