Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.
Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France.
HIV Med. 2019 Feb;20(2):175-181. doi: 10.1111/hiv.12697. Epub 2018 Dec 3.
The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment.
Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses.
Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL.
Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
本研究旨在评估在法国普遍治疗建议传播后，巴黎北部和东部地区的移民与欧洲本地人在开始联合抗逆转录病毒治疗（cART）的时机、cART 的选择和病毒学反应方面是否存在差异。
研究纳入了 2014 年 1 月 1 日至 2015 年 3 月 31 日期间在 15 个参与中心至少接受过两次随访的、初治 HIV-1 感染的成年患者。采用多变量逻辑回归模型评估了在 2015 年 3 月 31 日前开始 cART、在开始 cART 的个体中使用含蛋白酶抑制剂（PI）的 cART 以及 cART 启动后 1 年病毒学成功的相关因素。在分析中考虑了性别、年龄、原籍地区[西欧、撒哈拉以南非洲（SSA）或其他]、HIV 传播组、基线艾滋病状态、CD4 细胞计数和血浆病毒载量（VL）以及乙型和/或丙型肝炎病毒感染。
在 912 名患者中，仅有 584 名（64%）在研究期间开始 cART。调整后，与来自西欧的个体相比，来自 SSA 的移民启动 cART 的可能性和随后的病毒学反应可能性均减半[调整后的优势比（aOR）为 0.54；95%置信区间（CI）为 0.36-0.82；和 aOR 为 0.52；95%CI 为 0.28-0.98]。PI 包含的 cART 在来自 SSA 的移民、CD4 细胞计数较低的人和 VL 较高的人中更为常见。
即使在普遍 cART 建议和免费获得治疗的背景下，来自 SSA 的移民获得 cART 的时间仍然延迟，病毒学反应也较低。仍需努力为所有 HIV 感染者提供即时的 cART。
