Abstract
ObjectiveTo compare the time from entry into care for HIV infection until combination antiretroviral therapy (cART) initiation between migrants and non migrants in France, excluding late access to care.MethodsAntiretroviral-naïve HIV-1-infected individuals newly enrolled in the FHDH cohort between 2002–2010, with CD4 cell counts >200/μL and no previous or current AIDS events were included. In three baseline CD4 cell count strata (200–349, 350-499, ≥500/μL), we examined the crude time until cART initiation within three years after enrolment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrolment period, region of care, plasma viral load, and HBV/HBC coinfection.ResultsAmong 13338 individuals, 9605 (72.1%) were French natives (FRA), 2873 (21.4%) were migrants from sub-Saharan Africa/non-French West Indies (SSA/NFW), and 860 (6.5%) were migrants from other countries. Kaplan-Meier probabilities of cART initiation were significantly lower in SSA/NFW than in FRA individuals throughout the study period, regardless of the baseline CD4 stratum. After adjustment, the likelihood of cART initiation was respectively 15% (95%CI, 1–28) and 20% (95%CI, 2–38) lower in SSA/NFW men than in FRA men who had sex with men (MSM) in the 350-499 and ≥500 CD4 strata, while no difference was observed between other migrant groups and FRA MSM.ConclusionSSA/NFW migrant men living in France with CD4 >350/μL at entry into care are more likely to begin cART later than FRA MSM, despite free access to treatment. Administrative delays in obtaining healthcare coverage do not appear to be responsible.
Highlights
Migrants represent 8.4% of the whole population living in France with 5.3 million of persons [1], heterosexually acquired HIV infection in migrants accounted for 38% of the 6372 new diagnoses of HIV infection in 2012 [2]
In three baseline CD4 cell count strata (200–349, 350-499, 500/μL), we examined the crude time until combination antiretroviral therapy (cART) initiation within three years after enrolment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrolment period, region of care, plasma viral load, and HBV/HBC coinfection
Kaplan-Meier probabilities of cART initiation were significantly lower in sub-Saharan Africa (SSA)/non-French West Indies (NFW) than in French natives (FRA) individuals throughout the study period, regardless of the baseline CD4 stratum
Summary
Migrants represent 8.4% of the whole population living in France with 5.3 million of persons [1], heterosexually acquired HIV infection in migrants accounted for 38% of the 6372 new diagnoses of HIV infection in 2012 [2]. Heterosexual female migrants (1466 individuals, 23.0%) and heterosexual male migrants (960 individuals, 15.0%) were the second and third largest groups among the new diagnoses of HIV infection, after men who have sex with men (MSM), who accounted for 2648 new diagnoses (42.0%) [2]. Among people living with HIV engaged in care in France in 2010, fewer migrants received combination antiretroviral therapy (cART) for more than six months and fewer had plasma viral loads (pVL) below 50 cp/mL on treatment when compared to non migrant heterosexuals and MSM [8]
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