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. 2015 Mar 3;10(3):e0118492.
doi: 10.1371/journal.pone.0118492. eCollection 2015.

Later cART initiation in migrant men from sub-Saharan Africa without advanced HIV disease in France

Laure-Amélie de Monteynard  1 , Rosemary Dray-Spira  1 , Pierre de Truchis  2 , Sophie Grabar  3 , Odile Launay  4 , Jean-Luc Meynard  5 , Marie-Aude Khuong-Josses  6 , Jacques Gilquin  7 , David Rey  8 , Anne Simon  9 , Juliette Pavie  10 , Aba Mahamat  11 , Sophie Matheron  12 , Dominique Costagliola  1 , Sophie Abgrall  13 ; French Hospital Database on HIV
Collaborators, Affiliations

Later cART initiation in migrant men from sub-Saharan Africa without advanced HIV disease in France

Laure-Amélie de Monteynard et al. PLoS One. .

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 enrollment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrollment 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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Conflict of interest statement

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

Figures

Fig 1
Fig 1. Individuals selection.
Abbreviations: ADE, AIDS-defining event; cART, combination antiretroviral therapy; NRTI, Nucleoside Reverse Transcriptase Inhibitor.
Fig 2
Fig 2. Kaplan-Meier survival estimates of first-line cART initiation by geographic origin and CD4 cell counts [/μL] at enrolment.
Abbreviations: cART, combination antiretroviral therapy; FRA, French natives; SSA, sub-Saharan Africa; NFW, non-French West Indies; OTH, Other regions of the world.
Fig 3
Fig 3. Univariate and multivariate Hazard Ratios (HRs) for cART initiation according to geographic origin, gender and HIV transmission group in baseline CD4 cell count strata (Cox model).
* HR adjusted for age at enrolment, enrolment period, region of care, pVL at enrolment, and hepatitis B antigen and hepatitis C antibody status; Abbreviations: cART, Combination antiretroviral therapy; FRA, French natives; SSA, sub-Saharan Africa; NFW, non-French West Indies; OTH, Other regions of the world; MSM, Men who have sex with men.
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