Timing of combined antiretroviral treatment initiation in male and female migrants living with HIV in Western Europe

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Abstract

Background:

We evaluate differences in timing of cART (combined antiretroviral treatment) initiation by geographical origin in male and female HIV-positive patients in the Collaboration of Observational HIV Epidemiological Research Europe, a large European Collaboration of HIV Cohorts.

Methods:

We included individuals recruited in Western Europe between January 1997 and March 2013, with known geographical origin and at least 1 CD4+ cell count measurement while cART-naive. Timing of cART was assessed through modified time-to-event methods, in which a scale of CD4+ cell counts was used instead of time, with cART being the outcome. We estimated the median CD4+ cell count at cART initiation (estimated CD4+ levels at which the probability of having started cART is 50%) using Kaplan–Meier and adjusted hazard ratios of cART initiation using Cox regression.

Results:

Of 151 674 individuals, 110 592 (72.9%) were men. Median (95% confidence interval) CD4+ cell count falls far below 250 cells/μl in all groups and was lowest in sub-Saharan African [SSA: 161 (158–167)], Caribbean men [161 (150–174)] and in Asian women [Asian Continent and Oceania: 185 (165–197)]. Among men, the adjusted probability of cART initiation was lower in migrants compared with natives, but differences depended on initial CD4+ cell count. For example, in the group with more than 500 CD4+ at recruitment, they were 45% (36–53%), 30% (17–40%) and 25% (19–30%) lower for Caribbean, Eastern European and SSA men, respectively. In women, no meaningful differences were observed between natives and most migrant groups. However, SSA women had a 31% (24–38%) higher probability of cART initiation when recruited at a CD4+ more than 500 cells/μl and 9% (4–14%) lower when recruited at CD4+ less than 100 cells/μl.

Conclusion:

Most migrant men initiate cART at lower CD4+ cell count than natives, whereas this does not hold for migrant women.

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