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. 2025 Feb;26(2):252-264.
doi: 10.1111/hiv.13729. Epub 2024 Nov 4.

Viral rebound on antiretroviral therapy in France according to region of origin, sex, and HIV acquisition group. Results from the French Hospital Database on HIV (ANRS CO4-FHDH)

S Abgrall  1 , H Selinger-Leneman  2 , E Lanoy  2 , A Becker  3 , S Matheron  4 , P de Truchis  5 , J Pavie  6 , A Canestri  7 , M A Khuong  8 , D Rey  9 , F Caby  2   10 , P Tattevin  11 , R Palich  12 , S Grabar  13 ; ANRS CO4‐FHDH
Affiliations

Viral rebound on antiretroviral therapy in France according to region of origin, sex, and HIV acquisition group. Results from the French Hospital Database on HIV (ANRS CO4-FHDH)

S Abgrall et al. HIV Med. 2025 Feb.

Abstract

Background: Assessing the potential increased risk of viral rebound (VR) in migrants requires adequate control for sex and acquisition risk groups.

Methods: People living with HIV1, enrolled in the ANRS CO4-French Hospital Database on HIV, who achieved virological suppression with antiretroviral therapy (ART) initiated between 2006 and 2016 were included. We first compared the risk of VR, with loss to follow-up and death considered as competing events, across origin among the HIV acquisition groups, then across acquisition groups among the different origins, and finally across modality of a variable combining sex, acquisition group, and origin. Models were adjusted for clinical and biological confounding factors.

Results: We included 21 571 French natives (FRA), 10 148 migrants from sub-Saharan Africa (SSA), 1137 migrants from the non-French West Indies (NFWI), and 4205 other migrants (OTHER). The 5-year probability of VR was 19% (95% confidence interval [CI] 19-20) overall, 15% in FRA, 21% in OTHER, 26% in SSA, and 34% in NFWI (p < 0.0001). It was 14% in men who have sex with men (MSM), 23% in heterosexual men, and 23% in women (p < 0.0001). After adjustment, all acquisition groups had a higher risk of VR than MSM from FRA, with men and women from NFWI having the highest risk (adjusted hazard ratio [aHR] 2.46; 95% CI 2.12-2.86 and aHR 2.59; 95% CI 2.20-3.04, respectively). Within each acquisition group, all groups of origin had a higher risk of VR than FRA. Within each region of origin, except the NFWI, heterosexual men had a higher risk of VR than MSM.

Conclusions: After accounting for sex and acquisition group, migration, especially from NFWI, remains prognostic of VR.

Keywords: HIV; geographical origin; heterosexual; migrant; virological rebound.

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Conflict of interest statement

In the past 3 years, FC was a member of the French Gilead HIV board and of the ViiV board. PT was a scientific advisor for Gilead and Pfizer. DR has received travel/accommodations/meeting expenses from MSD. MKJ has received travel/accommodations/meeting expenses from Gilead and MSD and was a member of the ViiV board and the MSD board. RP has received travel/accommodations/meeting expenses and advisory fees from Gilead, ViiV Healthcare and Merck France. The remaining authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart participant selection. ANRS CO4‐FHDH, French Hospital Database on HIV‐ANRS CO4; ART, antiretroviral treatment; PLWH, people living with HIV.
FIGURE 2
FIGURE 2
Cumulative incident functions of viral rebound. (a) According to HIV sex acquisition group. (b) According to geographical region of origin. FRA, French natives; MSM, men who have sex with men; NFWI, non‐French West Indies; OTHER, other regions of the world; OthM, other men; SSA, sub‐saharan Africa.
FIGURE 3
FIGURE 3
Subdistribution hazard ratio (sdHR) of viral rebound. (a) By geographical region of origin according to sex and acquisition group. (b) By acquisition group according to geographical region of origin. (c) Combined by geographical region of origin and sex and acquisition group. CI, confidence interval; FRA, French natives; MSM, men who have sex with men; NFWI, non‐French West Indies; Other, other regions of the world; OthM, other men; SSA, sub‐Saharan Africa.
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