[Socio-demographic factors associated with the progression of HIV infection and the impact of HAART in a seroconverter cohort in Madrid (1986-2009)].
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.


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.


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.


CONCLUSIONS
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.
Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España. smonge@isciii.es
Susana
S
Monge
Jorge
J
Del Romero
Carmen
C
Rodríguez
Carmen
C
de Mendoza
Miguel
M
de Górgolas
Jaime
J
Cosín
Fernando
F
Dronda
Elisa
E
Pérez-Cecilia
José María
JM
Peña
Ignacio
I
Santos
Rafael
R
Rubio
Julia
J
Del Amo
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D008297:Male; D008962:Models, Theoretical; D011446:Prospective Studies; D012306:Risk; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
D019380:Anti-HIV Agents