de Monteynard Laure-Amélie, Matheron Sophie, Gilquin Jacques, Pavie Juliette, de Truchis Pierre, Grabar Sophie, Launay Odile, Meynard Jean-Luc, Khuong-Josses Marie-Aude, Rey David, Simon Anne, Mahamat Aba, Dray-Spira Rosemary, Costagliola Dominique, Abgrall Sophie
*Authors affiliations are listed in the Acknowledgments. †A complete list of contributors appears in the Acknowledgements section.
AIDS. 2016 Sep 10;30(14):2235-46. doi: 10.1097/QAD.0000000000001193.
More data are needed on the influence of geographic origin, sex, and the HIV transmission group on biological and clinical outcomes after first-line combined antiretroviral therapy (cART) initiation.
We studied antiretroviral-naive HIV-1-infected adults enrolled in the French Hospital Database on HIV cohort in France and who started cART between 2006 and 2011. The censoring date of the study was 31 December 2012. According to geographic origin [French natives (FRA) or sub-Saharan Africa/non-French West Indies (SSA/NFW)], sex, and HIV transmission group, we assessed 2-year Kaplan-Meier probabilities and adjusted hazard ratios (aHRs) for plasma viral load undetectability and CD4 cell recovery, and 5-year cumulative incidences and aHRs for negative clinical outcomes (AIDS-defining event, serious non-AIDS events, or death).
Of 9746 eligible individuals, 7297 (74.9%) were FRA and 2449 (25.1%) were sub-Saharan Africa/non-French West Indies migrants. More migrants (38.1%) than nonmigrants (27.5%) started cART with a CD4 cell count less than 200/μl (P < 0.0001). By comparison with FRA MSM, nonhomosexual men, whatever their geographic origin, had lower aHRs for viral undetectability; all patient groups, particularly migrants, had lower aHRs for CD4 cell recovery than FRA MSM; aHRs for negative clinical outcome (360 new AIDS-defining events, 1376 serious non-AIDS events, 38 deaths) were also higher in nonhomosexual men, regardless of geographic origin. Preexisting AIDS status, a lower CD4 cell count and older age at cART initiation had the biggest impact on changes between the crude and aHRs of clinical outcomes.
Compared with FRA MSM, all migrants had a lower likelihood of CD4 cell recovery, and nonhomosexual men had a higher likelihood of negative virological and clinical outcomes.
关于地理来源、性别和HIV传播群体对一线联合抗逆转录病毒疗法（cART）启动后生物学和临床结局的影响，需要更多数据。
我们研究了法国医院HIV队列数据库中纳入的初治HIV-1感染成人，他们于2006年至2011年间开始接受cART治疗。研究的截尾日期为2012年12月31日。根据地理来源[法国本土人（FRA）或撒哈拉以南非洲/非法属西印度群岛（SSA/NFW）]、性别和HIV传播群体，我们评估了血浆病毒载量不可检测和CD4细胞恢复的2年Kaplan-Meier概率及调整后的风险比（aHRs），以及不良临床结局（艾滋病定义事件、严重非艾滋病事件或死亡）的5年累积发病率和aHRs。
在9746名符合条件的个体中，7297名（74.9%）为法国本土人，2449名（25.1%）为撒哈拉以南非洲/非法属西印度群岛移民。开始cART时CD4细胞计数低于200/μl的移民（38.1%）多于非移民（27.5%）（P<0.0001）。与法国本土男男性行为者（FRA MSM）相比，无论地理来源如何，非同性恋男性病毒不可检测的aHRs较低；所有患者组，尤其是移民，CD4细胞恢复的aHRs低于FRA MSM；非同性恋男性不良临床结局（360例新的艾滋病定义事件、1376例严重非艾滋病事件、38例死亡）的aHRs也较高，无论地理来源如何。基线艾滋病状态、cART启动时较低的CD4细胞计数和较高的年龄对临床结局的粗风险比和调整后风险比之间的变化影响最大。
与FRA MSM相比，所有移民CD4细胞恢复的可能性较低，非同性恋男性病毒学和临床不良结局的可能性较高。
