Later cART Initiation in Migrant Men from Sub-Saharan Africa without Advanced HIV Disease in France

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Abstract

Objective

To compare the time from entry into care for HIV infection until combination antiretroviral therapy (cART) initiation between migrants and non migrants in France, excluding late access to care.

Methods

Antiretroviral-naïve HIV-1-infected individuals newly enrolled in the FHDH cohort between 2002–2010, with CD4 cell counts >200/μL and no previous or current AIDS events were included. In three baseline CD4 cell count strata (200–349, 350-499, ≥500/μL), we examined the crude time until cART initiation within three years after enrolment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrolment period, region of care, plasma viral load, and HBV/HBC coinfection.

Results

Among 13338 individuals, 9605 (72.1%) were French natives (FRA), 2873 (21.4%) were migrants from sub-Saharan Africa/non-French West Indies (SSA/NFW), and 860 (6.5%) were migrants from other countries. Kaplan-Meier probabilities of cART initiation were significantly lower in SSA/NFW than in FRA individuals throughout the study period, regardless of the baseline CD4 stratum. After adjustment, the likelihood of cART initiation was respectively 15% (95%CI, 1–28) and 20% (95%CI, 2–38) lower in SSA/NFW men than in FRA men who had sex with men (MSM) in the 350-499 and ≥500 CD4 strata, while no difference was observed between other migrant groups and FRA MSM.

Conclusion

SSA/NFW migrant men living in France with CD4 >350/μL at entry into care are more likely to begin cART later than FRA MSM, despite free access to treatment. Administrative delays in obtaining healthcare coverage do not appear to be responsible.

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Most cited references 8

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Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel.

Melanie Thompson, Judith Aberg, Pedro Cahn … (2010)

Recent data regarding the consequences of untreated human immunodeficiency virus (HIV) infection and the expansion of treatment choices for antiretroviral-naive and antiretroviral-experienced patients warrant an update of the International AIDS Society-USA guidelines for the use of antiretroviral therapy in adults with HIV infection. To provide updated recommendations for management of HIV-infected adults, using antiretroviral drugs and laboratory monitoring tools available in the international, developed-world setting. This report provides guidelines for when to initiate antiretroviral therapy, selection of appropriate initial regimens, patient monitoring, when to change therapy, and what regimens to use when changing. A panel with expertise in HIV research and clinical care reviewed relevant data published or presented at selected scientific conferences since the last panel report through April 2010. Data were identified through a PubMed search, review of scientific conference abstracts, and requests to antiretroviral drug manufacturers for updated clinical trials and adverse event data. New evidence was reviewed by the panel. Recommendations were drafted by section writing committees and reviewed and edited by the entire panel. The quality and strength of the evidence were rated and recommendations were made by full panel consensus. Patient readiness for treatment should be confirmed before initiation of antiretroviral treatment. Therapy is recommended for asymptomatic patients with a CD4 cell count 500/microL. Components of the initial and subsequent regimens must be individualized, particularly in the context of concurrent conditions. Patients receiving antiretroviral treatment should be monitored regularly; treatment failure should be detected and managed early, with the goal of therapy, even in heavily pretreated patients, being HIV-1 RNA suppression below commercially available assay quantification limits.

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Impact of late presentation on the risk of death among HIV-infected people in France (2003-2009).

Elisabeth Rouveix, Sophie Abgrall, Sophie Abgrall … (2013)

A recent consensus defines "late presentation" (LP) during the course of HIV infection as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells per cubic millimeter. Here, using this new definition, we examined the frequency and predictors of LP and its impact on mortality. In antiretroviral-naive patients enrolled in the French Hospital Database on HIV between 2003 and 2009, we studied risk factors for LP by multivariable logistic regression. The impact of LP on mortality was analyzed according to the level of immunodeficiency by using Cox multivariable models adjusted for potential confounders, with follow-up categorized into 0-6, 6-12, and 12-48 months. There were 11,038 (53.9%) late presenters among the 20,496 patients included in the study. Compared with patients presenting for care with CD4 ≥350 cells per cubic millimeter, patients presenting with AIDS had a very high risk of death with crude hazard ratio ranging from 48.3 during the first 6 months of follow-up to 4.8 during months 12-48; the corresponding values among AIDS-free patients with CD4 ≤200 cells per cubic millimeter were 8.1 and 2.3. Importantly, patients presenting with CD4 between 200 and 350 cells per cubic millimeter also had a significantly increased risk of death beyond 6 months of follow-up (hazard ratio: 3.0 and 1.8 for months 6-12 and 12-48, respectively). Results were similar after adjustment. LP with HIV infection is still very frequent in France and is associated with higher mortality, even among patients with only moderate immunodeficiency. Encouraging early testing and access to care is still urgently needed.

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HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

Tadgh McMahon, Paul Ward (2012)

Background Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention. Methods We undertook a realist review to answer the research question: ‘How are HIV prevention interventions in high-income countries adapted to suit immigrants’ needs?’ A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms. Results Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of ‘consonance’ mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms – ‘understanding’, ‘specificity’ and ‘embeddedness’ – which indicated that using the language of immigrants, usually the ‘mother tongue’, targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of ‘authenticity’ and ‘framing’ mechanisms and only partial evidence to support role of ‘endorsement’ mechanisms. Conclusions This realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.

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Author and article information

Contributors

Cristian Apetrei: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 3 March 2015

Publication date Collection: 2015

Volume: 10

Issue: 3

Electronic Location Identifier: e0118492

Affiliations

[1 ]Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France

[2 ]INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France

[3 ]AP-HP, Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond-Poincaré, Département de Médecine Aigüe Spécialisée, Garches, France

[4 ]Université Paris Descartes, Sorbonne Paris cité, Paris, France

[5 ]AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Unité de Biostatistique et Epidémiologie, Paris, France

[6 ]AP-HP, Hôpital Cochin, Paris, France

[7 ]AP-HP, Hôpital Saint Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France

[8 ]Centre Hospitalier Saint-Denis, Hôpital Delafontaine, Service des Maladies Infectieuses et Tropicales, Saint-Denis, France

[9 ]AP-HP, Hôpital Hôtel-Dieu, Unité d’immunoinfectiologie, Paris, France

[10 ]Hôpitaux Universitaire Strasbourg, Centre de Soins de l’Infection par le VIH, Strasbourg, France

[11 ]AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de médecine interne, Paris, France

[12 ]AP-HP, Hôpital Européen Georges Pompidou, Service d’immunologie clinique, Paris, France

[13 ]Centre Hospitalier Andrée Rosemon, Service des Maladies Infectieuses et Tropicales, Cayenne, France

[14 ]Université Paris Diderot, Sorbonne Paris cité, Paris, France

[15 ]AP-HP, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France

[16 ]AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France

University of Pittsburgh Center for Vaccine Research, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: LADM SA DC. Performed the experiments: LADM. Analyzed the data: LADM SA DC. Contributed reagents/materials/analysis tools: LADM. Wrote the paper: LADM SA DC. Has full access to all the data and takes the responsibility for the integrity of the data and the accuracy of the data analysis: LADM. Statistical expertise: SA DC. Interpretation of the data: LADM RDS PDT SG OL JLM MAKJ JG DR AS JP AM SM DC SA. Drafted the article: LADM SA. Critical revision of the article for important intellectual content: LADM SA DC. Final approval of the article: LADM RDS PDT SG OL JLM MAKJ JG DR AS JP AM SM DC SA.

¶ The full list of FHDH-ANRS CO4 investigators can be found in S1 Appendix

* E-mail: lmonteynard@ 123456ccde.chups.jussieu.fr

Article

Publisher ID: PONE-D-14-38721

DOI: 10.1371/journal.pone.0118492

PMC ID: 4348541

PubMed ID: 25734445

SO-VID: 7cc48be3-1449-4880-abb1-01821a2fe89e

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 11 September 2014

Date accepted : 12 December 2014

Page count

Figures: 3, Tables: 2, Pages: 13

Funding

This work was supported by the Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS), INSERM, and the French Ministry of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Data are not owned by the authors. SAS dataset "migrants1" is owned by 'Institut National de la Santé et de la Rechercherche Médicale(INSERM)' and the 'Ministère de la Santé'. Data requests may be submitted to the FHDH and must be approved by the French computer watchdog authority, la Commission Nationale de l’Informatique et des Libertés (CNIL). Data requests may be sent to Murielle Mary Krause at the FHDH ( mmary@ 123456ccde.chups.jussieu.fr ).

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Later cART Initiation in Migrant Men from Sub-Saharan Africa without Advanced HIV Disease in France

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Abstract

Objective

Methods

Results

Conclusion

Related collections

PLOS Climate

Most cited references 8

Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel.

Impact of late presentation on the risk of death among HIV-infected people in France (2003-2009).

HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

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