de Monteynard Laure-Amélie, Dray-Spira Rosemary, de Truchis Pierre, Grabar Sophie, Launay Odile, Meynard Jean-Luc, Khuong-Josses Marie-Aude, Gilquin Jacques, Rey David, Simon Anne, Pavie Juliette, Mahamat Aba, Matheron Sophie, Costagliola Dominique, Abgrall Sophie
Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
AP-HP, Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond-Poincaré, Département de Médecine Aigüe Spécialisée, Garches, France.
PLoS One. 2015 Mar 3;10(3):e0118492. doi: 10.1371/journal.pone.0118492. eCollection 2015.
To 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.
Antiretroviral-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 enrollment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrollment period, region of care, plasma viral load, and HBV/HBC coinfection.
Among 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.
SSA/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.
比较法国移民和非移民从确诊感染HIV到开始接受联合抗逆转录病毒治疗（cART）的时间，不包括延迟获得治疗的情况。
纳入2002年至2010年新加入FHDH队列的未接受过抗逆转录病毒治疗的HIV-1感染者，其CD4细胞计数>200/μL，且既往或当前无艾滋病事件。在三个基线CD4细胞计数分层（200 - 349、350 - 499、≥500/μL）中，我们根据地理来源检查了入组后三年内开始cART的原始时间，并根据地理来源、性别和HIV传播组检查了多变量风险比，同时对基线年龄、入组时间、治疗地区、血浆病毒载量和HBV/HBC合并感染进行了调整。
在13338名个体中，9605名（72.1%）为法国本土人（FRA），2873名（21.4%）为撒哈拉以南非洲/非法属西印度群岛的移民（SSA/NFW），860名（6.5%）为来自其他国家的移民。在整个研究期间，无论基线CD4分层如何，SSA/NFW人群开始cART的Kaplan-Meier概率均显著低于FRA人群。调整后，在350 - 499和≥500 CD4分层中，SSA/NFW男性开始cART的可能性分别比FRA男男性行为者（MSM）低15%（95%CI，1 - 28）和20%（95%CI，2 - 38），而其他移民群体与FRA MSM之间未观察到差异。
在法国接受治疗时CD4>350/μL的SSA/NFW移民男性比FRA MSM更有可能延迟开始cART，尽管可免费获得治疗。获得医疗保健覆盖方面的行政延迟似乎并非原因所在。
