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


CONCLUSIONS
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.
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.
Aysel
A
Gueler
Franziska
F
Schoeni-Affolter
André
A
Moser
Barbara
B
Bertisch
Heiner C
HC
Bucher
Alexandra
A
Calmy
Matthias
M
Cavassini
Bruno
B
Ledergerber
Gilles
G
Wandeler
Matthias
M
Egger
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013557:Switzerland / Q000453:epidemiology; D019562:Viral Load