Socioeconomic status as a predictor of the rate of progression in HIV positive homosexual men.

The Vancouver Lymphadenopathy-AIDS study a prospective study of homosexual men sought to identify socioeconomic factors associated with slower progression of HIV infection. 2 analysis were conducted within a cohort study of 729 homosexual men between November 1982 and December 1984 in Vancouver Canada. The 1st was a case-control study comparing 41 nonprogressors (who at a follow-up visit during October 1989-December 1990 had been HIV positive for at least 5 years were at CDC Stage III or less and had never received zidovudine against Pneumocystis carinii pneumonia) with 41 rapid progressors (who had developed AIDS other than Kaposis sarcoma within 6 years of seroconversion or enrollment). Progressors were individually matched to nonprogressors on the basis of date of enrollment if seroprevalent and date of seroconversion if seroincident. Socioeconomic data were taken from a questionnaire at enrollment during 1982-84. 85% of non progressors vs. 62% of progressors had annual incomes above $10000 at enrollment (p = 0.019). 100% of the non progressors vs. 84% of rapid progressors had finished secondary school (p = 0.008). 35% of non progressors vs. 15% of progressors were employed in management and professional positions. The 2nd analysis was a longitudinal one that evaluated CD4 cell count decline in 278 seropositive men between 2 visits prior to July 1987 when zidovudine became available. Between these visits subjects with annual incomes above $10000 at enrollment experienced a lower mean rate of CD4 cell loss than those with lower incomes (-40 vs. -95 cells/mm3/year; p = 0.037). Those who finished secondary school had a less pronounced rate of CD4 cell loss than those who did not (-50 vs. -86 cells/mm3/year). Possible additional elements of the host-agent-environment interaction (modalities including psychosocial factors and nutrition) but affected by socioeconomic status were likely to be involved in this lesser susceptibility to the effects of HIV.