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Multicenter Study

Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis

Antiretroviral Therapy Cohort Collaboration (ART-CC) et al. AIDS. .

Abstract

Objective: In lower-income countries rates of AIDS-defining events (ADEs) and death are high during the first year of combination antiretroviral therapy (ART). We investigated differences between foreign-born (migrant) and native-born (nonmigrant) patients initiating ART in Europe, the US and Canada, and examined rates of the most common ADEs and mortality during the first year of ART.

Design: Observational cohort study.

Methods: We studied HIV-positive adults participating in one of 12 cohorts in the Antiretroviral Therapy Cohort Collaboration (ART-CC).

Results: Of 48 854 patients, 25.6% were migrants: 16.1% from sub-Saharan Africa, 5.6% Latin America, 2.3% North Africa/Middle East, and 1.6% Asia. Incidence of ADEs during the first year of ART was 60.8 per 1000 person-years: 69.9 for migrants and 57.7 for nonmigrants [crude hazard ratio (HR) 1.18; 95% confidence interval (CI) 1.08-1.29], adjusted HR (for sex, age, CD4, HIV-1 RNA, ART regimen, prior ADE, probable route of infection and year of initiation, and stratified by cohort) 1.21 (95% CI 1.09-1.34). Rates of tuberculosis were substantially higher in migrants than nonmigrants (14.3 vs. 6.3; adjusted HR 1.94; 95% CI 1.53-2.46). In contrast, mortality was higher among nonmigrants than migrants (crude HR 0.71; 95% CI 0.61-0.84), although excess mortality was partially explained by patient characteristics at start of ART (adjusted HR 0.91; 95% CI 0.76-1.09).

Conclusions: During the first year of ART, HIV-positive migrants had higher rates of ADEs than nonmigrants. Tuberculosis was the most common ADE among migrants, highlighting the importance of screening for tuberculosis prior to ART initiation in this population.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1. Incidence of AIDS defining events (upper panels) and death (lower panels) by region of origin (nonmigrants vs. migrantsin left panels; migrants separated into specific region of origin in right panels)
Fig. 2
Fig. 2. Hazard ratios for ADE, ADE not including TB, and death in the first year of ART initiation by region of origin
The reference group is nonmigrants. All models are adjusted for sex, age, baseline CD4, baseline HIV-1 RNA, type of initial ART, prior ADE, probable route of infection, and year of ART initiation. ADE, AIDS-defining event; ART, antiretroviral therapy; TB, tuberculosis.
Fig. 3
Fig. 3. Hazard ratios for specific ADE in the first year of ART initiation comparing migrants with nonmigrants (reference group)
All models are adjusted for sex, age, baseline CD4, baseline HIV-1 RNA, type of initial ART, prior ADE, probable route of infection, and year of ART initiation. ADE, AIDS-defining event; ART, antiretroviral therapy.
See this image and copyright information in PMC

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