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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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Chappell E, Kohns Vasconcelos M, Goodall RL, Galli L, Goetghebuer T, Noguera‐Julian A, Rodrigues LC, Scherpbier H, Smit C, Bamford A, Crichton S, Navarro ML, Ramos JT, Warszawski J, Spolou V, Chiappini E, Venturini E, Prata F, Kahlert C, Marczynska M, Marques L, Naver L, Thorne C, Gibb DM, Giaquinto C, Judd A, Collins IJ. Children living with HIV in Europe: do migrants have worse treatment outcomes? HIV Med 2022; 23:186-196. [PMID: 34596323 PMCID: PMC9293243 DOI: 10.1111/hiv.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of migrant status on treatment outcomes among children living with HIV in Europe. METHODS Children aged < 18 years at the start of antiretroviral therapy (ART) in European paediatric HIV observational cohorts where ≥ 5% of children were migrants (defined as born abroad) were included. Three outcomes were considered: (i) severe immunosuppression-for-age; (ii) viraemic viral load (≥ 400 copies/mL) at 1 year after ART initiation; and (iii) AIDS/death after ART initiation. The effect of migrant status was assessed using univariable and multivariable logistic and Cox models. RESULTS Of 2620 children included across 12 European countries, 56% were migrants. At ART initiation, migrant children were older than domestic-born children (median 6.1 vs. 0.9 years, p < 0.001), with slightly higher proportions being severely immunocompromised (35% vs. 33%) and with active tuberculosis (2% vs. 1%), but a lower proportion with an AIDS diagnosis (14% vs. 19%) (all p < 0.001). At 1 year after beginning ART, a lower proportion of migrant children were viraemic (18% vs. 24%) but there was no difference in multivariable analysis (p = 0.702), and no difference in severe immunosuppression (p = 0.409). However, there was a trend towards higher risk of AIDS/death in migrant children (adjusted hazard ratio = 1.51, 95% confidence interval: 0.96-2.38, p = 0.072). CONCLUSIONS After adjusting for characteristics at ART initiation, migrant children have virological and immunological outcomes at 1 year of ART that are comparable to those who are domestic-born, possibly indicating equity in access to healthcare in Europe. However, there was some evidence of a difference in AIDS-free survival, which warrants further monitoring.
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Affiliation(s)
| | - Malte Kohns Vasconcelos
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
- Institute for Medical Microbiology and Hospital HygieneHeinrich Heine University DüsseldorfDüsseldorfGermany
- Paediatric Infectious Diseases Research GroupInstitute for Infection and ImmunitySt. George's, University of LondonLondonUK
| | | | - Luisa Galli
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Tessa Goetghebuer
- Department of PediatricsHôpital St PierreUniversité libre de BruxellesBruxellesBelgium
| | - Antoni Noguera‐Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases UnitDepartment of PediatricsSant Joan de Déu Hospital Research FoundationBarcelonaSpain
- Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP)MadridSpain
- Department of PediatricsUniversity of BarcelonaBarcelonaSpain
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
| | - Laura C. Rodrigues
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Henriette Scherpbier
- Emma Children's Hospital/Amsterdam University Medical CentreAmsterdamThe Netherlands
| | - Colette Smit
- Stichting HIV MonitoringAmsterdamThe Netherlands
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCLLondonUK
- Great Ormond Street Hospital for Children NHS TrustLondonUK
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Marissa Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
- Hospital General Universitario "Gregorio Marañón"MadridSpain
- Universidad ComplutenseMadridSpain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM)MadridSpain
| | - Jose T. Ramos
- Departamento de Salud Pública y Materno‐infantilUniversidad ComplutenseHospital Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridSpain
| | - Josiane Warszawski
- Service d'Epidémiologie et Santé PubliqueAP‐HPHôpital BicêtreLe Kremlin‐BicêtreFrance
- Unité de Recherche Clinique Paris Descartes Necker CochinAP‐HPParisFrance
| | - Vana Spolou
- First Department of PaediatricsInfectious Diseases Unit, “Agia Sophia” Childrens' HospitalAthensGreece
| | - Elena Chiappini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Elisabetta Venturini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | | | - Christian Kahlert
- Children's Hospital of Eastern Switzerland and Cantonal HospitalInfectious Diseases and Hospital EpidemiologySt GallenSwitzerland
| | | | - Laura Marques
- Centro Hospitalar e Universitário do PortoPortoPortugal
| | - Lars Naver
- Karolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Carlo Giaquinto
- Department of Women and Child HealthUniversity of PadovaPadovaItaly
| | - Ali Judd
- MRC Clinical Trials Unit at UCLLondonUK
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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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Cuzin L, Cotte L, Delpierre C, Allavena C, Valantin MA, Rey D, Delobel P, Pugliese P, Raffi F, Cabié A. Too fast to stay on track? Shorter time to first anti-retroviral regimen is not associated with better retention in care in the French Dat'AIDS cohort. PLoS One 2019; 14:e0222067. [PMID: 31490985 PMCID: PMC6730866 DOI: 10.1371/journal.pone.0222067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/21/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rapid antiretroviral therapy (ART) initiation has been proven beneficial for patients and the community. We aimed to analyze recent changes in timing of ART initiation in France and consequences of early start. METHODS We selected from a prospective nationwide cohort, on 12/31/2017, patients with HIV-1 infection diagnosed between 01/01/2010 and 12/31/2015. We described time from (1) diagnosis to first specialized medical encounter, (2) from this encounter to ART initiation, (3) from diagnosis to first undetectable HIV viral load (VL). We analyzed the determinants of measured temporal trends. A multivariate logistic regression was performed to assess characteristics related with 1-year retention in care. RESULTS In the 7 245 included patients, median time (1) from HIV diagnosis to first medical encounter was 13 (IQR: 6-32) days, (2) to ART initiation was 27 (IQR: 9-91) days, decreasing from 42 (IQR: 13-272) days in 2010 to 18 (IQR: 7-42) in 2015 (p<0.0001), (3) to first undetectable VL was 257 (IQR: 151-496) days, decreasing from 378 (IQR: 201-810) days in 2010 to 169 (IQR: 97-281) in 2015. After one year, proportion of patients alive and still in care was significantly lower in those in the lower quartile of time from first encounter to ART (<9 days) than those in the higher quartile (>90 days), 79.9% and 85.2%, respectively (p<0.0001). CONCLUSIONS In a country with unrestricted rapid access to ART, keeping recently diagnosed HIV infected patients in care remains challenging. Starting ART rapidly did not seem to be profitable for all and every patient.
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Affiliation(s)
- L. Cuzin
- Infectious and Tropical Diseases Unit, University Hospital of Martinique, Fort de France, France
- INSERM UMR1017, Toulouse III University, Toulouse, France
- * E-mail:
| | - L. Cotte
- Infectious Disease Unit, Hospices Civils de Lyon, Lyon, France
| | - C. Delpierre
- INSERM UMR1017, Toulouse III University, Toulouse, France
| | - C. Allavena
- Infectious Diseases Unit, Hotel Dieu University Hospital of Nantes, Nantes, France
| | - M-A. Valantin
- Infectious Diseases Unit, University Hospital of Pitié-Salpêtrière, Paris, France
| | - D. Rey
- HIV Infection Care Centre, University Hospital, Strasbourg, France
| | - P. Delobel
- Infectious and Tropical Diseases Unit, Purpan University Hospital, Toulouse, France
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - P. Pugliese
- Infectious Diseases Unit, University Hospital of Nice, Nice, France
| | - F. Raffi
- Infectious Diseases Unit, Hotel Dieu University Hospital of Nantes, Nantes, France
- CIC 1413, INSERM, Nantes, France
| | - A. Cabié
- Infectious and Tropical Diseases Unit, University Hospital of Martinique, Fort de France, France
- CIC1424, INSERM, Fort-de-France, France
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