AIDS. 2017 Mar 27;31(6):835-846. doi: 10.1097/QAD.0000000000001411.
We evaluate differences in timing of cART (combined antiretroviral treatment) initiation by geographical origin in male and female HIV-positive patients in the Collaboration of Observational HIV Epidemiological Research Europe, a large European Collaboration of HIV Cohorts.
We included individuals recruited in Western Europe between January 1997 and March 2013, with known geographical origin and at least 1 CD4 cell count measurement while cART-naive. Timing of cART was assessed through modified time-to-event methods, in which a scale of CD4 cell counts was used instead of time, with cART being the outcome. We estimated the median CD4 cell count at cART initiation (estimated CD4 levels at which the probability of having started cART is 50%) using Kaplan-Meier and adjusted hazard ratios of cART initiation using Cox regression.
Of 151 674 individuals, 110 592 (72.9%) were men. Median (95% confidence interval) CD4 cell count falls far below 250 cells/μl in all groups and was lowest in sub-Saharan African [SSA: 161 (158-167)], Caribbean men [161 (150-174)] and in Asian women [Asian Continent and Oceania: 185 (165-197)]. Among men, the adjusted probability of cART initiation was lower in migrants compared with natives, but differences depended on initial CD4 cell count. For example, in the group with more than 500 CD4 at recruitment, they were 45% (36-53%), 30% (17-40%) and 25% (19-30%) lower for Caribbean, Eastern European and SSA men, respectively. In women, no meaningful differences were observed between natives and most migrant groups. However, SSA women had a 31% (24-38%) higher probability of cART initiation when recruited at a CD4 more than 500 cells/μl and 9% (4-14%) lower when recruited at CD4 less than 100 cells/μl.
Most migrant men initiate cART at lower CD4 cell count than natives, whereas this does not hold for migrant women.
在欧洲观察性HIV流行病学研究协作组（一个大型欧洲HIV队列协作组）中，我们评估了按地理来源划分的男性和女性HIV阳性患者开始联合抗逆转录病毒治疗（cART）的时间差异。
我们纳入了1997年1月至2013年3月在西欧招募的个体，这些个体地理来源已知，且在未接受cART治疗时至少有1次CD4细胞计数测量值。通过改良的事件发生时间方法评估cART的开始时间，该方法使用CD4细胞计数量表而非时间，以开始cART作为结局。我们使用Kaplan-Meier法估计开始cART时的CD4细胞计数中位数（开始cART概率为50%时的估计CD4水平），并使用Cox回归调整cART开始的风险比。
在151674名个体中，110592名（72.9%）为男性。所有组的CD4细胞计数中位数（95%置信区间）均远低于250个细胞/μl，在撒哈拉以南非洲地区（SSA：161（158 - 167））、加勒比地区男性（161（150 - 174））和亚洲女性（亚洲大陆和大洋洲：185（165 - 197））中最低。在男性中，与本地男性相比，移民开始cART的调整概率较低，但差异取决于初始CD4细胞计数。例如，在招募时CD4细胞计数超过500的组中，加勒比地区、东欧和SSA地区男性开始cART的概率分别低45%（36 - 53%）、30%（17 - 40%）和25%（19 - 30%）。在女性中，本地女性与大多数移民群体之间未观察到有意义的差异。然而，SSA地区女性在招募时CD4细胞计数超过500个细胞/μl时开始cART的概率高31%（24 - 38%），而在招募时CD4细胞计数低于100个细胞/μl时开始cART的概率低9%（4 - 14%）。
大多数移民男性开始cART时的CD4细胞计数低于本地男性，而移民女性并非如此。
