Mariem Raho-Moussa, Sophie Abgrall et al. « Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France », PLOS One, Mars 2019


Barriers to achieve sustained HIV viro­lo­gical suppres­sion on anti­re­tro­viral therapy (ART) jeopar­dize the success of the 90:90:90 UNAIDS initia­tive which aims to end the HIV/​AIDS epidemic. In France, where access to ART is free and univer­sally avai­lable, we analyze the way in which social deter­mi­nants of health (i.e. cultural, envi­ron­mental) and economic factors might influence viro­lo­gical outcomes.

A cross-sectional study was performed in two hospi­tals located in Paris area. All conse­cu­tive people living with HIV (PLHIV) on ART for at least 6 months atten­ding the outpa­tient clinics between 01/​05/​2013 and 31/​10/​2014 answered an indi­vi­dual score of depri­va­tion, EPICES, retrie­ving infor­ma­tion on health insu­rance status, economic status, family support and leisure acti­vity. This score varies from 0 to 100 with depri­va­tion state defined above 30.17. Factors asso­ciated with HIV viral load >50 copies/​ml were assessed by logistic regres­sion mode­ling with a back­ward step­wise selec­tion to select the final multi­va­riable model. Sensi­ti­vity analyses were performed using two other thre­sholds for viro­lo­gical non-suppres­sion (100 or 200 copies/​ml).

Overall, 475 PLHIV were included (53% male, median age 47 years, 66% not born in France mainly in a sub-Saharan African country). Half of French natives and 85% of migrants were clas­si­fied as deprived. Median dura­tion on ART was 9.7 years with viro­lo­gical suppres­sion in 95.2% of non-deprived parti­ci­pants and in 83.5% of deprived ones (p = 0.001). The final multi­va­riable model retained ART tired­ness, younger age, a previous AIDS event and social depri­va­tion (adjusted Odds Ratio, 2.9 ; 95%CI, 1.2–7.0) as deter­mi­nants of viro­lo­gical non-suppres­sion but not migra­tion in itself. When using sepa­rate compo­nents of EPICES score, repor­ting economic diffi­cul­ties and non-homeow­ner­ship were asso­ciated with viro­lo­gical non-suppres­sion. In addi­tion to inter­ven­tions focu­sing on cultural aspects of migra­tion, social inter­ven­tions are needed to help people with social vulne­ra­bi­lity to obtain sustained responses on ART.