Low level of education increases chances of AIDS death in first four months of PI therapy

HIV-positive people with lower educational qualifications are more likely to die within four months of starting HAART, according to a French study published in the 1 September edition of the Journal of Infectious Diseases.

The APROCO study enrolled 1155 people at 47 HIV treatment centres in France who started a HAART regimen containing a protease inhibitor between May 1997 and June 1998. At baseline the study population had an average age of 36 years; CD4 count of 288 cells/mm³; and a viral load of 25,000 copies/mL. People on the study received follow-up every four months. In total, during the first four months of treatment 48 deaths occurred, 44% of which were AIDS-related, with a further 27% having a cause possibly related to HIV.

Investigators established that the factors, at baseline and at four-month follow-up associated with an increased risk of death were a CD4 count below 200 copies/mm³, low haemoglobin levels, low plasma creatine levels, suggestive of impaired kidney function, abnormal liver tests, and low educational attainment, defined in the study as failure to complete secondary education.

“School education level is probably a proxy for psychological, behavioural or social characteristics” comment the investigators, adding, “in our study, the association between school education and mortality remained after taking into account early response to treatment.”

The investigators speculate that the increased mortality risk for people with lower educational qualifications may be associated with poorer adherence, however they also suggest that it “may in part be related in part to advanced disease status.”

In conclusion the investigators suggest that “the higher risk of death in patients with a low level of education needs to be further evaluated to identify potential reasons (eg difficulty in treatment adherence, social problems, or high-risk behavior (sic))".