Effect of socio-economic class on the clinical stages of hiv infection at presentation

Objective: One of the factors determining susceptibility to infection is the socioeconomic environment of individuals. This study is therefore to determine the effect of socioeconomic factors on the clinical stage of HIV at which patients present. Patients and Methods: One hundred and sixty-five (165) adult HIV positive patients who were managed at HIV clinic of University of Ilorin teaching hospital, Ilorin were recruited for the study. The patients were recruited before the commencement of antiretroviral (ARV) drugs over a period of 13 months. Fifty (50) age and sex matched, HIV negative patients served as controls. A questionnaire was administered to the patients to assess their socioeconomic class as well as demographic factors. The subjects were grouped into the stages using clinical and immunological criteria. The clinical staging was done through clerking and physical examination while immunological staging was by CD4 cell count. The CD4 count was done by flow cytometry using Partec cyflow counter machine made in Germany, with strict adherence to the manufacturer’s standard operating procedure. Total lymphocyte count were determined using standard haematological technique. They were also grouped into various socio-economic class using the Oyedeji social class categorization (similar to Registrar General social class). Statistical analysis of data was done using statistical package for social sciences (SPSS) and statistical significance of data was based on P value of less than 0.05. Result: Statistically significant association was observed between the socioeconomic class and the stages of HIV infection (p-value 0.001). Majority of the patients in socio economic class 1 (SEC1), which are the high socioeconomic class were found in clinical stage 1. Most of the SEC 3 and 4 which are the low socioeconomic class group were found in late stages of HIV infection irrespective of high CD4 count. Conclusion: It can be concluded from this study that patients with high socioeconomic status tend to present with less severe disease than their low socioeconomic counterpart. Thus improving the socioeconomic status of the populace (especially people living with HIV infection) may facilitate early detection with eventual reduction in morbidity and mortality due to their better quality of life.