C Gatey, S. Abgrall et al. « Does region of origin influence the timing and outcome of first-​line antiretroviral therapy in France ? », HIV Medicine, Fev. 2019

Objec­tives. 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.

Methods. 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.

Results. 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.

Conclu­sions. 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.