HIV Med. 2018 Jan;19(1):42-48. doi: 10.1111/hiv.12536. Epub 2017 Jul 25.
The aim of the study was to evaluate differences in immunovirological response to combination antiretroviral therapy (cART) in migrant and native men and women within a European collaboration of HIV cohorts Collaboration of Observational HIV Epidemiological Research in Europ (COHERE) in EuroCoord, 2004-2013.
Migrants were defined as those with geographical origin (GO) different from the reporting country and were grouped as originating from Western Europe and Western Countries (WEWC), Eastern Europe (EE), North Africa and the Middle East (NAME), sub-Saharan Africa (SSA), Latin America (LA), Caribbean (CRB) and Asia/Oceania (ASIA/OCE). Native (NAT) individuals were defined as those originating from the reporting country. CD4 cell counts were modelled using piecewise linear mixed-effects models with two slopes, whereas models to estimate subdistribution hazard ratios (sHRs) were used for time to virological response (VR) (i.e. time from cART initiation to the first of two successive HIV RNA measurements < 400 HIV-1 RNA copies/ml).
Of 32 817 individuals, 25 799 (78.6%) were men. The percentage of migrants was higher in women (48.9%) than in men (21.2%) and migrants from SSA accounted for the largest migrant group (29.9% in men and 63.3% in women). Migrant men and women from SSA started at lower CD4 cell counts than NAT individuals, which remained lower over time. VR was ≥ 85% at 12 months for all groups except CRB women (77.7%). Compared with NAT men and women, lower VR was experienced by NAME [sHR 0.91; 95% confidence interval (CI) 0.86-0.97] and SSA (sHR 0.88; 95% CI 0.82-0.95) men and CRB (sHR 0.77; 85% CI 0.67-0.89) women, respectively.
Immunovirological response to cART in Western Europe varies by GO and sex of patients. ART benefits are not equal for all, underlining the point that efforts need to prioritize those most in need.
本研究旨在评估 2004 年至 2013 年期间，在欧洲合作的 HIV 队列合作组织（COHERE）中的 EuroCoord 中，移民和本地男性和女性对联合抗逆转录病毒疗法（cART）的免疫病毒学反应差异。
移民定义为地理来源（GO）与报告国不同的人群，并分为来自西欧和西方国家（WEWC）、东欧（EE）、北非和中东（NAME）、撒哈拉以南非洲（SSA）、拉丁美洲（LA）、加勒比（CRB）和亚洲/大洋洲（ASIA/OCE）。本地（NAT）个体定义为来自报告国的个体。CD4 细胞计数采用两段线性混合效应模型进行建模，而用于估计亚分布危险比（sHR）的模型则用于病毒学反应（即从 cART 开始到两次连续 HIV RNA 测量中第一次 <400 HIV-1 RNA 拷贝/ml 的时间）的时间。
在 32817 名个体中，25799 名（78.6%）为男性。女性中移民的比例（48.9%）高于男性（21.2%），来自 SSA 的移民占最大的移民群体（男性占 29.9%，女性占 63.3%）。来自 SSA 的移民男性和女性开始时的 CD4 细胞计数低于 NAT 个体，并且随着时间的推移，这些计数一直较低。除了 CRB 女性（77.7%）外，所有组在 12 个月时的 VR 均≥85%。与 NAT 男性和女性相比，NAME（sHR 0.91；95%置信区间（CI）0.86-0.97）和 SSA（sHR 0.88；95%CI 0.82-0.95）男性以及 CRB（sHR 0.77；85%CI 0.67-0.89）女性的 VR 较低。
西欧对 cART 的免疫病毒学反应因患者的 GO 和性别而异。ART 带来的益处并非对所有人平等，这强调了需要优先考虑最需要的人群的重要性。
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