Migrants from Sub-Saharan Africa in the Swiss HIV Cohort Study: access to antiretroviral therapy, disease progression and survival.
OBJECTIVE
To examine the proportion of migrants from Sub-Saharan Africa entering the Swiss HIV Cohort Study (SHCS) and to compare these participants with participants from Northwestern Europe for access to antiretroviral therapy, progression to AIDS and survival.


METHODS
Prospective national cohort study of HIV-1-infected adults from seven HIV centres in Switzerland.


METHODS
Trends in the proportion of participants from Sub-Saharan Africa were followed in 11 872 HIV-infected adults entering the SHCS from 1984 to 2001. Survival methods were used to compare uptake of antiretroviral therapy, survival and progression to AIDS in the 2684 participants from Sub-Saharan Africa and Northwest Europe enrolled from 1997-2001.


RESULTS
There was a steady increase in the proportion of Sub-Saharan African participants over time, reaching 11.9% in 1997-2001. These participants were more likely to be younger, female, to have been infected by heterosexual intercourse and had lower CD4 cell counts at presentation. There were no differences between Sub-Saharan Africans and Northwest Europeans in uptake of triple antiretroviral therapy, progression to AIDS or survival up to 48 months after starting treatment. Tuberculosis was the most frequent AIDS-defining event in Sub-Saharan African patients.


CONCLUSIONS
There is no evidence that access to potent antiretroviral therapy is influenced by geographic origin of participants. The prognosis of Sub-Saharan African patients on triple therapy is equivalent to that of Northwest European patients. Future research should address wider issues about access to specialist health services for HIV-infected people from Sub-Saharan Africa.
Staehelin
Cornelia
C
Division of Infectious Diseases, University Hospital Berne, Berne, Switzerland.
Rickenbach
Martin
M
Low
Nicola
N
Egger
Martin
M
Ledergerber
Bruno
B
Hirschel
Bernard
B
D'Acremont
Valérie
V
Battegay
Manuel
M
Wagels
Thomas
T
Bernasconi
Enos
E
Kopp
Christine
C
Furrer
Hansjakob
H
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000379:methods; D018450:Disease Progression; D004641:Emigration and Immigration; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D015497:HIV-1; D006297:Health Services Accessibility; D020010:Heterosexuality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012737:Sex Factors
D044966:Anti-Retroviral Agents