Socioeconomic status (SES) as a determinant of adherence to treatment in HIV infected patients: a systematic review of the literature

We searched the PubMed database to identify studies concerning SES and HIV/AIDS and collected data regarding the association between various determinants of SES (income, education, occupation) and adherence.We initially identified 116 potentially relevant articles and reviewed in detail 17 original studies, which contained data that were helpful in evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. No original research study has specifically focused on the possible association between SES and adherence to treatment of patients with HIV/AIDS. Among the reviewed studies that examined the impact of income and education on adherence to antiretroviral treatment, only half and less than a third, respectively, found a statistically significant association between these main determinants of SES and adherence of patients infected with HIV/AIDS.Our systematic review of the available evidence does not provide conclusive support for existence of a clear association between SES and adherence among patients infected with HIV/AIDS. There seemed to be a positive trend among components of SES (income, education, occupation) and adherence to antiretroviral treatment in many of the reviewed studies, however most of the studies did not establish a statistically significant association between determinants of SES and adherence.Suboptimal adherence to medical treatment with antiretroviral agents has been associated with increased morbidity and mortality, potential transmission of drug-resistant virus, drug resistance, and failure to achieve viral suppression [1-4]. Adherence to treatment in patients infected with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) is influenced by factors associated with the patient, the disease, the patient-physician relationship, and the therapy [1-5]. Patient related determinants are socioeconomic status (SES), demographic, psychological, cognitive and behavioral characteristics