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Birth Country Influences the Choice of Antiretroviral Therapy in HIV-Infected Individuals: Experience From a French HIV Centre. J Acquir Immune Defic Syndr 2023; 92:144-152. [PMID: 36257296 DOI: 10.1097/qai.0000000000003114] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess whether antiretroviral therapy (ART) prescriptions differ between naive and virally suppressed HIV patients born in France (PBFs) and in Sub-Saharan Africa (PBSSAs). SETTING Observational single-center study. METHODS We included all PBFs and PBSSAs who entered into care at Pitié-Salpêtrière Hospital, Paris, France, from 01/01/2000 to 31/12/2018, with plasma HIV-RNA>200 copies/mL. We first compared the initial ART in naive PBFs and PBSSAs. Second, we compared the last-prescribed ART (including drug-reduced ART: daily 2-drug regimens, daily 1-drug regimens and intermittent 3-drug regimens) in virally suppressed PBFs and PBSSAs, by focusing on patients in care in 2018 with HIV-RNA <50 copies for at least 24 months. A univariable and multivariable logistic regression model was used to assess the impact of geographical origin on ART prescriptions. RESULTS A total of 1944 naive patients were included (915 PBSSAs and 1029 PBFs). PBSSAs were more frequently women, hepatitis B coinfected, with a lower pretherapeutic CD4 T-cell count, and most had tuberculosis at HIV diagnosis. After adjustment for confounders, PBSSAs were more likely to receive a first-line protease inhibitor-based regimen (OR 1.61, 95% CI: 1.31 to 1.98), and less likely to receive an integrase inhibitor-based regimen (OR 0.61, 95% CI: 0.42 to 0.88). Of the 968 virally suppressed patients (431 PBSSAs and 537 PBFs), PBSSAs were less likely to receive drug-reduced ART, including 2-drug regimens and intermittent three-drug regimens (OR 0.48, 95% CI: 0.36 to 0.65). CONCLUSIONS Differences in ART prescriptions between PBSSAs and PBFs were not only explained by different clinical and virologic situations. Personal motivations of doctors in choosing ART according to country of birth need to be explored.
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Abgrall S, Raho-Moussa M, Seng R, Ghislain M, Matheron S, Pialoux G, Goujard C, Meyer L. Elevated risk of viral rebound on ART in migrants living in France: role of socioeconomic factors. Antivir Ther 2020; 24:541-552. [PMID: 31868654 DOI: 10.3851/imp3339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Western countries, viral rebound on antiretroviral therapy (ART) appears to occur more frequently in migrants. We aimed to assess the respective roles of socioeconomic factors and migration on viral rebound in people living with HIV (PLHIV) in France. METHODS We included PLHIV in France, enrolled from 2004 to 2008 in the French ANRS-COPANA cohort, who started a first ART and achieved undetectability (<50 copies/ml) within 1 year. Determinants of viral rebound were assessed using Cox models including geographical origin, HIV transmission group, and clinicobiological and sociodemographic data. RESULTS Of 499 included individuals, 288 were born in France, 158 in sub-Saharan Africa (SSA) and 53 in another country. Kaplan-Meier probabilities of viral rebound-free survival were similar for men having sex with men (MSM) and heterosexuals born in France, and lower in migrants from SSA or other countries (P<0.001). The crude hazard ratio (HR) of viral rebound was 2.49 (95% CI, 1.59, 3.90) in migrants from SSA and 1.78 (0.94, 3.88) in migrants from other countries compared with MSM born in France. Educational level, financial difficulties and HIV status disclosure had the biggest impact on the difference between the crude and adjusted HRs for viral rebound in migrants. In multivariable analysis, viral rebound was no longer associated with geographical origin, but with protease inhibitor-containing ART, a VACS index ≥35 as a potential indicator of frailty, poor financial status (difficulties or debts) and non-disclosure to friend(s). CONCLUSIONS Socioeconomic factors affect outcomes on ART, even in the context of free access to HIV care and treatment. Patient-centred strategies should be encouraged with the intervention of social workers to address basic needs and promote social support for more socially vulnerable individuals.
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Affiliation(s)
- Sophie Abgrall
- APHP, Hôpital Béclère, Service de Médecine Interne, Clamart, France.,APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Mariem Raho-Moussa
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Rémonie Seng
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Mathilde Ghislain
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Sophie Matheron
- APHP, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gilles Pialoux
- APHP, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France.,UPMC, Univ Paris 06, Paris, France
| | - Cécile Goujard
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France.,APHP, Hôpital Bicêtre, Service de Médecine Interne, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France.,APHP, Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France
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Pistone T, Ouattara E, Gabillard D, Lele N, Duvignaud A, Cordel H, Malvy D, Bouchaud O, Abgrall S. Travel-related health events and their risk factors in HIV-infected sub-Saharan migrants living in France and visiting their native country: The ANRS VIHVO cohort study. Travel Med Infect Dis 2019; 29:40-47. [PMID: 30951905 DOI: 10.1016/j.tmaid.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/20/2019] [Accepted: 03/28/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Literature on health events in HIV-infected travellers is scarce, particularly in sub-Saharan African (SSA) migrants. METHODS We investigated health events in HIV-infected SSA migrants living in France during and after travel to their native country. All had a pre-travel plasma viral load (pVL) below 200 copies/mL and were on stable combined antiretroviral therapy (cART). Logistic regression models were used to assess the risk factors for at least one adverse health event or febrile event. RESULTS Among 264 HIV migrants, pre-travel median CD4 count was 439/mm3 and 27 migrants (6%) experienced a low-level viremia between 50 and 200 copies/mL. One hundred (38%) experienced at least one event (13 experienced two events). The most common events were gastrointestinal, including diarrhoea (n = 29, 26%), respiratory events (n = 20, 18%), and malaria (n = 17, 15%; 1 death). In multivariable analysis, a pre-travel low-level viremia and a lack of pre-travel medical advice significantly increased the risk for any event (OR 4.31, 95% CI, 1.41-13.1; and OR 3.62, 95% CI, 1.38-9.47; respectively). A lack of pre-travel advice significantly increased the risk for febrile event. CONCLUSIONS Early and tailored counselling on pre-travel medical advice regarding diarrhoea and vector-borne diseases prophylactic measures in HIV-infected SSA migrants should be emphasised before travel to Africa.
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Affiliation(s)
- Thierry Pistone
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Eric Ouattara
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Delphine Gabillard
- Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Nathalie Lele
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Alexandre Duvignaud
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Hugues Cordel
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Denis Malvy
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Olivier Bouchaud
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Sophie Abgrall
- AP-HP, Hôpital Antoine Béclère, Clamart, France; Inserm U1018, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Le Kremlin-Bicêtre Cedex, Université Paris Sud University, Paris Saclay University, France.
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