1. Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy
- Author
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Saracino, Annalisa, Zaccarelli, Mauro, Lorenzini, Patrizia, Bandera, Alessandra, Marchetti, Giulia, Castelli, Francesco, Gori, Andrea, Girardi, Enrico, Mussini, Cristina, Bonfanti, Paolo, Ammassari, Adriana, D'Arminio Monforte, Antonella, Moroni, M., Andreoni, M., Angarano, G., Antinori, A., D'Arminio Monforte, A., Castelli, F., Cauda, R., Di Perri, G., Galli, M., Iardino, R., Ippolito, G., Lazzarin, A., Perno, C. F., Von Schloesser, F., Viale, P., Castagna, A., Ceccherini-Silberstein, F., Cozzi-Lepri, A., Girardi, E., Lo Caputo, S., Mussini, C., Puoti, M., Ammassari, A., Balotta, C., Bonfanti, P., Bonora, S., Borderi, M., Capobianchi, M. R., Cingolani, A., Cinque, P., De Luca, A., Di Biagio, A., Gianotti, N., Gori, A., Guaraldi, G., Lapadula, G., Lichtner, M., Madeddu, G., Maggiolo, F., Marchetti, G., Marcotullio, S., Monno, L., Quiros Roldan, E., Rusconi, S., Saracino, A., Cicconi, P., Fanti, I., Galli, L., Lorenzini, P., Shanyinda, M., Tavelli, A., Giacometti, A., Costantini, A., Mazzoccato, S., Santoro, C., Suardi, C., Vanino, E., Verucchi, G., Minardi, C., Quirino, T., Abeli, C., Manconi, P. E., Piano, P., Vecchiet, J., Falasca, K., Sighinolfi, L., Segala, D., Mazzotta, F., Cassola, G., Viscoli, C., Alessandrini, A., Piscopo, R., Mazzarello, G., Mastroianni, C., Belvisi, V., Caramma, I., Chiodera, A., Castelli, A. P., Rizzardini, G., Ridolfo, A. L., Piolini, R., Salpietro, S., Carenzi, L., Moioli, M. C., Tincati, C., Puzzolante, C., Abrescia, N., Chirianni, A., Borgia, G., Guida, M. G., Gargiulo, M., Gentile, I., Orlando, R., Baldelli, F., Francisci, D., Parruti, G., Ursini, T., Magnani, G., Ursitti, M. A., Vullo, V., D'Avino, A., Gallo, L., Nicastri, E., Acinapura, R., Capozzi, M., Libertone, R., Tebano, G., Zaccarelli, M., Viviani, F., Sasset, L., Mura, M. S., Rossetti, B., Caramello, P., Orofino, G. C., Sciandra, M., Bassetti, M., Londero, A., Pellizzer, G., Manfrin, V., Saracino, A., Zaccarelli, M., Lorenzini, P., Bandera, A., Marchetti, G., Castelli, F., Gori, A., Girardi, E., Mussini, C., Bonfanti, P., Ammassari, A., D'Arminio Monforte, A., Moroni, M., Andreoni, M., Angarano, G., Antinori, A., Cauda, R., Di Perri, G., Galli, M., Iardino, R., Ippolito, G., Lazzarin, A., Perno, C. F., Von Schloesser, F., Viale, P., Castagna, A., Ceccherini-Silberstein, F., Cozzi-Lepri, A., Lo Caputo, S., Puoti, M., Balotta, C., Bonora, S., Borderi, M., Capobianchi, M. R., Cingolani, A., Cinque, P., De Luca, A., Di Biagio, A., Gianotti, N., Guaraldi, G., Lapadula, G., Lichtner, M., Madeddu, G., Maggiolo, F., Marcotullio, S., Monno, L., Quiros Roldan, E., Rusconi, S., Cicconi, P., Fanti, I., Galli, L., Shanyinda, M., Tavelli, A., Giacometti, A., Costantini, A., Mazzoccato, S., Santoro, C., Suardi, C., Vanino, E., Verucchi, G., Minardi, C., Quirino, T., Abeli, C., Manconi, P. E., Piano, P., Vecchiet, J., Falasca, K., Sighinolfi, L., Segala, D., Mazzotta, F., Cassola, G., Viscoli, C., Alessandrini, A., Piscopo, R., Mazzarello, G., Mastroianni, C., Belvisi, V., Caramma, I., Chiodera, A., Castelli, A. P., Rizzardini, G., Ridolfo, A. L., Piolini, R., Salpietro, S., Carenzi, L., Moioli, M. C., Tincati, C., Puzzolante, C., Abrescia, N., Chirianni, A., Borgia, G., Guida, M. G., Gargiulo, M., Gentile, I., Orlando, R., Baldelli, F., Francisci, D., Parruti, G., Ursini, T., Magnani, G., Ursitti, M. A., Vullo, V., D'Avino, A., Gallo, L., Nicastri, E., Acinapura, R., Capozzi, M., Libertone, R., Tebano, G., Viviani, F., Sasset, L., Mura, M. S., Rossetti, B., Caramello, P., Orofino, G. C., Sciandra, M., Bassetti, M., Londero, A., Pellizzer, G., Manfrin, V., Saracino, A, Zaccarelli, M, Lorenzini, P, Bandera, A, Marchetti, G, Castelli, F, Gori, A, Girardi, E, Mussini, C, Bonfanti, P, Ammassari, A, D'Arminio Monforte, A, Moroni, M, Andreoni, M, Angarano, G, Antinori, A, Cauda, R, Di Perri, G, Galli, M, Iardino, R, Ippolito, G, Lazzarin, A, Perno, C, Von Schloesser, F, Viale, P, Castagna, A, Ceccherini-Silberstein, F, Cozzi-Lepri, A, Lo Caputo, S, Puoti, M, Balotta, C, Bonora, S, Borderi, M, Capobianchi, M, Cingolani, A, Cinque, P, De Luca, A, Di Biagio, A, Gianotti, N, Guaraldi, G, Lapadula, G, Lichtner, M, Madeddu, G, Maggiolo, F, Marcotullio, S, Monno, L, Quiros Roldan, E, Rusconi, S, Cicconi, P, Fanti, I, Galli, L, Shanyinda, M, Tavelli, A, Giacometti, A, Costantini, A, Mazzoccato, S, Santoro, C, Suardi, C, Vanino, E, Verucchi, G, Minardi, C, Quirino, T, Abeli, C, Manconi, P, Piano, P, Vecchiet, J, Falasca, K, Sighinolfi, L, Segala, D, Mazzotta, F, Cassola, G, Viscoli, C, Alessandrini, A, Piscopo, R, Mazzarello, G, Mastroianni, C, Belvisi, V, Caramma, I, Chiodera, A, Castelli, A, Rizzardini, G, Ridolfo, A, Piolini, R, Salpietro, S, Carenzi, L, Moioli, M, Tincati, C, Puzzolante, C, Abrescia, N, Chirianni, A, Borgia, G, Guida, M, Gargiulo, M, Gentile, I, Orlando, R, Baldelli, F, Francisci, D, Parruti, G, Ursini, T, Magnani, G, Ursitti, M, Vullo, V, D'Avino, A, Gallo, L, Nicastri, E, Acinapura, R, Capozzi, M, Libertone, R, Tebano, G, Viviani, F, Sasset, L, Mura, M, Rossetti, B, Caramello, P, Orofino, G, Sciandra, M, Bassetti, M, Londero, A, Pellizzer, G, Manfrin, V, Bandera, Alessandra, Perno, C.F., Capobianchi, M.R., Manconi, P.E., Castelli, A.P., Ridolfo, A.L., Moioli, M.C., Guida, M.G., Ursitti, M.A., Mura, M.S., Orofino, G.C., and on behalf of the Icona Foundation Study, Group
- Subjects
Male ,0301 basic medicine ,Social Determinants of Health ,HIV Infections ,Socioeconomic Factor ,Health Services Accessibility ,Social determinant ,Men who have sex with men ,Cohort Studies ,0302 clinical medicine ,Risk Factors ,Universal Health Insurance ,Epidemiology ,Medicine ,HIV Infection ,030212 general & internal medicine ,lcsh:Public aspects of medicine ,Middle Aged ,Antiretroviral therapy ,Treatment Outcome ,Anti-Retroviral Agents ,Italy ,Antiretroviral therapy, HIV, ICONA, Social determinants ,Cohort ,HIV ,ICONA ,Social determinants ,Public Health, Environmental and Occupational Health ,Female ,Public Health ,Human ,Research Article ,Cohort study ,Adult ,medicine.medical_specialty ,NO ,03 medical and health sciences ,Humans ,Social determinants of health ,Risk factor ,business.industry ,Risk Factor ,Environmental and Occupational Health ,antiretroviral therapy ,hiv ,icona ,social determinants ,public health ,environmental and occupational health ,lcsh:RA1-1270 ,030112 virology ,Discontinuation ,Regimen ,Socioeconomic Factors ,Anti-Retroviral Agent ,Cohort Studie ,business ,Demography - Abstract
Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.
- Published
- 2018
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