Socioeconomic status and survival of persons with AIDS before and after the introduction of highly active antiretroviral therapy

We estimated the AIDS survival by neighborhood socioeconomic status before (1993-1995) and after (1996-1997) the introduction of highly active antiret roviral therapy in Rome, Italy, in a retrospective cohort of persons with A IDS followed through July 31, 1998. Participants included 1,474 persons wit h AIDS residing in Rome who were diagnosed in 1993-1997. We calculated haza rd ratios (HRs) of death for two diagnostic periods (before and after highl y active antiretroviral therapy was introduced) by neighborhood socioeconom ic status categorized into four levels (level I = highest socioeconomic sta tus), using the Cox model and adjusting fur gender, age, intravenous drug u se, CD4 cell count at diagnosis, AIDS-defining disease, and hospital of dia gnosis. Thirty-four per cent of persons with AIDS (N = 503) had survived as of mid-1998. For persons with AIDS diagnosed in 1993-1995, we found little difference in the risk of death by neighborhood socioeconomic status. For 1996-1997, the risk of death was greater for persons with lower neighborhoo d socioeconomic status, especially for levels III and IV [HR = 2.81 (95% co nfidence interval = 1.38-5.76), and HR = 2.55 (95% confidence interval = 1. 27-5.14), respectively, compared with level I]. Stratified analyses showed that the greatest difference was found for women and drug users. In conclus ion, even in a country with universal health coverage that Provides therapy at no cost, differences in survival of persons with AIDS have emerged by n eighborhood socioeconomic status since highly active antiretroviral therapy was introduced. Inequalities in health care access or in medical managemen t, or poor adherence to treatment, could explain the observed heterogeneity .