The influence of the patients' educational levels on socioeconomic, clinical, immunological and virological end-points
Résumé
To analyze the influence of educational levels on diverse baseline and follow-up characteristics and outcomes of HIV-infected patients, we sequentially evaluated 1352 patients with known educational levels, who initiated a nelfinavir-based regimen. Higher educational degrees were associated with better baseline clinical (P=0.03) and immunological (P=0.003) conditions, not related to transmission categories, which were also observed during follow-up (P=0.003). However, these differences were only observed in antiretroviral-experienced patients (P=0.002), as naïve patients had very similar values (P=0.8). Overall there were somewhat different CD4 responses (P=0.06), but not viral load responses (P=0.6), to antiretroviral therapy according to the educational level, but these differences were more marked in the last 6 months of follow-up (P=0.008). Patients with higher educational degrees had higher rates of adherence to medical appointments both before (P=0.0003) and during the study period (P=0.01), as well as to antiretroviral therapy in univariate (P=0.003) and multivariate analyses (P=0.007). Similarly, baseline CD4 counts proved to be independently associated with education after adjustment for other variables (P=0.0006). The educational groups also differed in diverse socioeconomic parameters and certain beliefs about HIV infection (P<0.0001 for each). We conclude that educational level has an influence on clinical and immunological outcomes of HIV infection, probably through differences in the long-term effects of treatment as a result of adherence to antiretroviral therapy and to medical indications. The evaluation of social aspects such as the patients' education should be incorporated into routine practice to improve the results of treatment.
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