Do HIV-Infected Immigrants Initiating HAART have Poorer Treatment-Related Outcomes than Autochthonous Patients in Spain? Results of the GESIDA 5808 Study

Jose      A. Perez-Molina; Marta      Mora Rillo; Ignacio      Suarez-Lozano; Jose      L. Casado Osorio; Ramon      Teira Cobo; Pablo      Rivas Gonzalez; Enric      Pedrol Clotet; Asuncion      Hernando Jerez; Pere      Domingo Pedrol; Ana      Royuela; Elena      Barquilla Diaz; Herminia      Esteban; Juan      Gonzalez-Garcia

Abstract

Objective: Currently, 12% of the Spanish population is foreign-born, and a third of newly diagnosed HIV- infected patients are immigrants. We determined whether being an immigrant was associated with a poorer response to antiretroviral treatment. Methods: Historical multicenter cohort study of naive patients starting HAART. The primary endpoint was time to treatment failure (TTF) defined as virological failure (VF), death, opportunistic disease, treatment discontinuation (D/C), or missing patient. Secondary endpoints were TTF expressed as observed data (TFO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/C not due to VF). A multivariate analysis was performed to control for confounders. Results: A total of 1090 treatment-naive HIV-infected patients (387 immigrants and 703 autochthonous) from 33 hospitals were included. Most immigrants were from Sub-Saharan Africa (28.3%) or South-Central America/Caribbean (31%). Immigrants were significantly younger (34 y vs 39 y), more frequently female (37.5% vs 24.6%), with less HCV coinfection than autochthonous patients (7% vs 31.3%). There were no differences in baseline viral load (4.95 Log10 vs 4.98 Log10), CD4 lymphocyte count (193.5/μL vs 201.5/μL), late initiation of HAART (56.4% vs 56.0%), or antiretrovirals used. Cox-regression analysis (HR; 95%CI) did not show differences in TTF (0.89; 0.66-1.20), TFO (0.95; 0.66-1.36), or TVF (1.00; 0.57-1.78) between immigrants and autochthonous patients. Losses to follow-up were more frequent among immigrants (17.8% vs 12.1; p=0.009). Sub-Saharan African patients and immigrant females had a significantly shorter TTF. Conclusions: The response to HAART among immigrant patients was similar to that of autochthonous patients, although they had a higher rate of losses to follow-up. Sub-Saharan Africans and immigrant females may need particular measures to avoid barriers hindering antiviral efficacy.

Keywords: Immigrants, antiretroviral therapy, HAART, Sub-Saharan Africans, Latin Americans, cohort studies, ethnic groups, HIV-Infected Immigrants, Autochthonous Patients, Spain, GESIDA 5808 Study, antiretroviral treatment, HIV-infected patients, Sub-Saharan Africa, South-Central America, lymphocyte count, tuberculosis, HIV, HBV, non-B subtypes, antiretroviral drugs, HIV-associated symptoms, HIV-1 RNA levels, interquartile range, multivariate Cox regression, Cox analysis, Schoenfeld residuals, HIV infection, CD4 lymphocyte, Pneumocystis, jiroveci, Kaposi sarcoma, oesophageal candidiasis, progressive multifocal leukoencephalopathy, low-density lipoprotein cholesterol, aspartate aminotransferase, triglycerides, high-density lipoprotein cholesterol, alanine aminotransferase, gammaglutamyl transpeptidase, GES-5808