Socioeconomic Determinants of Mortality in HIV

Burkey, Matthew D.; Weiser, Sheri D.; Fehmie, Desiree; Alamo-Talisuna, Stella; Sunday, Pamella; Nannyunja, Joy; Reynolds, Steven J.; Chang, Larry W.

doi:10.1097/qai.0000000000000094

Cited by 21 publications

(15 citation statements)

References 32 publications

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“…Unemployed urban participants had a higher risk of mortality, a finding that concurs with previous research ( 38 – 41 ). HIV care was provided at no cost in both sites irrespective of their employment status.…”

Section: Discussionsupporting

confidence: 92%

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Factors associated with mortality in HIV-infected people in rural and urban South Africa

Otwombe

Petzold

Modisenyane

et al. 2014

Global Health Action

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BackgroundFactors associated with mortality in HIV-infected people in sub-Saharan Africa are widely reported. However rural–urban disparities and their association with all-cause mortality remain unclear. Furthermore, commonly used classical Cox regression ignores unmeasured variables and frailty.ObjectiveTo incorporate frailty in assessing factors associated with mortality in HIV-infected people in rural and urban South Africa.DesignUsing data from a prospective cohort following 6,690 HIV-infected participants from Soweto (urban) and Mpumalanga (rural) enrolled from 2003 to 2010; covariates of mortality were assessed by the integrated nested Laplace approximation method.ResultsWe enrolled 2,221 (33%) rural and 4,469 (67%) urban participants of whom 1,555 (70%) and 3,480 (78%) were females respectively. Median age (IQR) was 36.4 (31.0–44.1) in rural and 32.7 (28.2–38.1) in the urban participants. The mortality rate per 100 person-years was 11 (9.7–12.5) and 4 (3.6–4.5) in the rural and urban participants, respectively. Compared to those not on HAART, rural participants had a reduced risk of mortality if on HAART for 6–12 (HR: 0.20, 95% CI: 0.10–0.39) and >12 months (HR: 0.10, 95% CI: 0.05–0.18). Relative to those not on HAART, urban participants had a lower risk if on HAART >12 months (HR: 0.35, 95% CI: 0.27–0.46).The frailty variance was significant and >1 in rural participants indicating more heterogeneity. Similarly it was significant but <1 in the urban participants indicating less heterogeneity.ConclusionThe frailty model findings suggest an elevated risk of mortality in rural participants relative to the urban participants potentially due to unmeasured variables that could be biological, socio–economic, or healthcare related. Use of robust methods that optimise data and account for unmeasured variables could be helpful in assessing the effect of unknown risk factors thus improving patient management and care in South Africa and elsewhere.

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Section: Discussionsupporting

confidence: 92%

“…Other studies have shown that mortality could be affected by poor social situations such as unemployment, poor housing, and social isolation. Furthermore, these factors may influence one’s health negatively ( 38 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with mortality in HIV-infected people in rural and urban South Africa

Otwombe

Petzold

Modisenyane

et al. 2014

Global Health Action

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“…Importantly, lower education has also been associated with virologic failure in this cohort (Cardoso et al, 2014), which likely contributes to our findings. Lower education may be an indicator of lower socio-economic status (Szwarcwald, Souza-Junior, & Damacena, 2010), which has also been associated with increased mortality risk (Burkey et al, 2014). We also observed an approximately two-fold increased mortality risk among persons with AIDS defining illnesses, consistent with prior results from our cohort that showed that AIDS defining illnesses increased risk of AIDS-related and non-AIDS related deaths (Grinsztejn et al, 2013) [REF].…”

Section: Discussionmentioning

confidence: 99%

Poor retention in early care increases risk of mortality in a Brazilian HIV-infected clinical cohort

et al. 2016

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Retention in early HIV care has been associated with decreased mortality and improved viral suppression, however the consequences of poor retention in early care in Brazil remain unknown. We assessed the effect of poor retention on mortality in a Brazilian HIV-infected clinical cohort. The analysis included ART-naïve, HIV-infected adults linked to care at the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz between 2000 and 2010, who did not become pregnant nor participate in a clinical trial during the first two years in care (early care). Poor retention in early care was defined as less than 3 out of 4 six-month intervals with a CD4 or HIV-1 RNA laboratory result during early care. Cox proportional hazards models were used to identify factors associated with mortality, and Kaplan-Meier plots were used to describe the survival probability for participants with poor retention versus good retention. Among 1054 participants with a median (interquartile range) follow-up time of 4.2 years (2.6, 6.3), 20% had poor retention in early care and 8% died. Poor early retention [adjusted hazard ratio (aHR) 3.09; 95% CI 1.65–5.79], AIDS defining illness (aHR 1.95; 95% CI 1.20–3.18), lower education (aHR 2.33; 95% CI 1.45–3.75) were associated with increased mortality risk. Our findings highlight the importance of adopting strategies to improve retention in early HIV care.

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“…Furthermore, H . pylori infection is considered a disease of poverty, and poor socioeconomic status has been associated with rather disadvantageous outcomes of HIV infection [ 3 ]. The underlying mechanisms for this observed association are unclear.…”

Section: Introductionmentioning

confidence: 99%

Helicobacter pylori Infection Is Associated with Higher CD4 T Cell Counts and Lower HIV-1 Viral Loads in ART-Naïve HIV-Positive Patients in Ghana

et al. 2015

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BackgroundWorldwide, there is a high co-endemicity of HIV and H. pylori infection and there is growing evidence that H. pylori co-infection is associated with parameters of HIV disease progression. The objective of this study was to investigate the prevalence of H. pylori infection, and the association with clinical, immunological and virological parameters in a large cohort of HIV-infected individuals and uninfected controls in a West African country.MethodsHIV-patients (n = 1,095) and HIV-negative individuals (n = 107) were recruited at a university hospital in Ghana. H. pylori status was determined using stool antigen testing. HIV-related, clinical and socio-demographic parameters were recorded and analyzed according to H. pylori status.ResultsThe prevalence of H. pylori infection was significantly lower in HIV-positive compared to HIV-negative individuals (51.5 vs. 88%, p<0.0001). In HIV patients, H. pylori prevalence decreased in parallel with CD4+ T cell counts. In ART-naïve HIV-infected individuals, but not in those taking ART, H. pylori infection was associated with higher CD4 cell counts (312 vs. 189 cells/μL, p<0.0001) and lower HIV-1 viral loads (4.92 vs. 5.21 log10 copies/mL, p = 0.006). The findings could not be explained by socio-demographic confounders or reported use of antibiotics. Having no access to tap water and higher CD4+ T cell counts were identified as risk factors for H. pylori infection.Conclusions H. pylori prevalence was inversely correlated with the degree of immunosuppression. In ART-naïve individuals, H. pylori infection is associated with favorable immunological and virological parameters. The underlying mechanisms for this association are unclear and warrant investigation.

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Socioeconomic Determinants of Mortality in HIV

Cited by 21 publications

References 32 publications

Factors associated with mortality in HIV-infected people in rural and urban South Africa

Factors associated with mortality in HIV-infected people in rural and urban South Africa

Poor retention in early care increases risk of mortality in a Brazilian HIV-infected clinical cohort

Helicobacter pylori Infection Is Associated with Higher CD4 T Cell Counts and Lower HIV-1 Viral Loads in ART-Naïve HIV-Positive Patients in Ghana

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