在西班牙，开始接受高效抗逆转录病毒治疗（HAART）的HIV感染移民的治疗相关结果是否比本地患者更差？GESIDA 5808研究结果

Do HIV-Infected Immigrants Initiating HAART have Poorer Treatment-Related Outcomes than Autochthonous Patients in Spain? Results of the GESIDA 5808 Study.

作者信息

Pérez Molina José A, Rillo Marta Mora, Suárez-Lozano Ignacio, Casado Osorio Jose L, Cobo Ramón Teira, González Pablo Rivas, Clotet Enric Pedrol, Jerez Asunción Hernando, Pedrol Pere Domingo, Royuela Ana, Díaz Elena Barquilla, Esteban Herminia, González-García Juan

机构信息

Tropical Medicine Unit, Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9,100, Madrid 28034, Spain.

出版信息

Curr HIV Res. 2010 Oct;8(7):521-30. doi: 10.2174/157016210793499178.

DOI:10.2174/157016210793499178

PMID:21073441

Abstract

OBJECTIVE

currently, 12% of the Spanish population is foreign-born, and a third of newly diagnosed HIV-infected patients are immigrants. We determined whether being an immigrant was associated with a poorer response to antiretroviral treatment.

METHODS

historical multicenter cohort study of naïve patients starting HAART. The primary endpoint was time to treatment failure (TTF) defined as virological failure (VF), death, opportunistic disease, treatment discontinuation (D/C), or missing patient. Secondary endpoints were TTF expressed as observed data (TFO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/C not due to VF). A multivariate analysis was performed to control for confounders.

RESULTS

a total of 1090 treatment-naïve HIV-infected patients (387 immigrants and 703 autochthonous) from 33 hospitals were included. Most immigrants were from Sub-Saharan Africa (28.3%) or South-Central America/Caribbean (31%). Immigrants were significantly younger (34 y vs. 39 y), more frequently female (37.5% vs. 24.6%), with less HCV coinfection than autochthonous patients (7% vs. 31.3%). There were no differences in baseline viral load (4.95 Log(10) vs. 4.98 Log(10)), CD4 lymphocyte count (193.5/µL vs. 201.5/µL), late initiation of HAART (56.4% vs. 56.0%), or antiretrovirals used. Cox-regression analysis (HR; 95%CI) did not show differences in TTF (0.89; 0.66-1.20), TFO (0.95; 0.66-1.36), or TVF (1.00; 0.57-1.78) between immigrants and autochthonous patients. Losses to follow-up were more frequent among immigrants (17.8% vs. 12.1; p=0.009). Sub-Saharan African patients and immigrant females had a significantly shorter TTF.

CONCLUSIONS

the response to HAART among immigrant patients was similar to that of autochthonous patients, although they had a higher rate of losses to follow-up. Sub-Saharan Africans and immigrant females may need particular measures to avoid barriers hindering antiviral efficacy.

摘要

目的

目前，12%的西班牙人口出生在国外，新诊断的HIV感染患者中有三分之一是移民。我们确定移民是否与抗逆转录病毒治疗反应较差有关。

方法

对开始接受高效抗逆转录病毒治疗（HAART）的初治患者进行历史性多中心队列研究。主要终点是治疗失败时间（TTF），定义为病毒学失败（VF）、死亡、机会性疾病、治疗中断（D/C）或患者失访。次要终点是以观察数据表示的TTF（TFO；对失访患者进行截尾）和病毒学失败时间（TVF；对失访患者和非因VF导致的D/C进行截尾）。进行多变量分析以控制混杂因素。

结果

纳入了来自33家医院的1090例初治HIV感染患者（387例移民和703例本地患者）。大多数移民来自撒哈拉以南非洲（28.3%）或中美洲/加勒比地区（31%）。移民明显更年轻（34岁对39岁），女性比例更高（37.5%对24.6%），与本地患者相比，丙型肝炎病毒合并感染率更低（7%对31.3%）。基线病毒载量（4.95 Log(10)对4.98 Log(10)）、CD4淋巴细胞计数（193.5/µL对201.5/µL）、HAART开始较晚（56.4%对56.0%）或使用的抗逆转录病毒药物方面没有差异。Cox回归分析（风险比；95%置信区间）显示移民和本地患者在TTF（0.89；0.66 - 1.20）、TFO（0.95；0.66 - 1.36）或TVF（1.00；0.57 - 1.78）方面没有差异。移民中的失访情况更常见（17.8%对12.1%；p = 0.009）。撒哈拉以南非洲患者和移民女性的TTF明显更短。