C Gatey1, A Brun2, G Hamet2, S Diamantis3, P Sellier4, O Bouchaud5,6, V Garrait7, W Rozenbaum1,2, J M Molina1,8, S Abgrall9,10,11. 1. Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France. 2. Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France. 3. Department of Infectious Diseases, Marc Jacquet Hospital, Melun, France. 4. Department of Internal Medicine, Saint Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France. 5. Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France. 6. Laboratory Health Education and Practice (LEPS EA 3412), Paris 13 University, Bobigny, France. 7. Department of Internal Medicine, Intercommunal Hospital Centre, Créteil, France. 8. University of Paris Diderot, Sorbonne Paris University, Paris, France. 9. Department of Internal Medicine, Antoine Béclère Hospital, Clamart, France. 10. University of Paris Saclay, Paris-Sud University, UVSQ, Le Kremlin-Bicêtre, France. 11. CESP INSERM U1018, Le Kremlin-Bicêtre, France.
Abstract
OBJECTIVES: The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. METHODS: Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. RESULTS: Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. CONCLUSIONS: Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
OBJECTIVES: The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. METHODS: Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. RESULTS: Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. CONCLUSIONS: Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
Authors: Elizabeth Chappell; Malte Kohns Vasconcelos; Ruth L Goodall; Luisa Galli; Tessa Goetghebuer; Antoni Noguera-Julian; Laura C Rodrigues; Henriette Scherpbier; Colette Smit; Alasdair Bamford; Siobhan Crichton; Marissa Luisa Navarro; Jose T Ramos; Josiane Warszawski; Vana Spolou; Elena Chiappini; Elisabetta Venturini; Filipa Prata; Christian Kahlert; Magdalena Marczynska; Laura Marques; Lars Naver; Claire Thorne; Diana M Gibb; Carlo Giaquinto; Ali Judd; Intira Jeannie Collins Journal: HIV Med Date: 2021-10-01 Impact factor: 3.094
Authors: L Cuzin; L Cotte; C Delpierre; C Allavena; M-A Valantin; D Rey; P Delobel; P Pugliese; F Raffi; A Cabié Journal: PLoS One Date: 2019-09-06 Impact factor: 3.240