Heterogeneous response to HAART across a diverse population of people living with HIV: results from the ANRS-EN12-VESPA Study.
OBJECTIVE
Benefits from HAART may be heterogeneous across people living with HIV. We measured the differences in the rate of HAART failure across the various subgroups represented at the level of a country.


METHODS
We used data from a national representative sample of people living with HIV and followed at hospital in France (ANRS-EN12-VESPA Study).


METHODS
Analyses were restricted to 896 participants on HAART for 6 months or more, who were antiretroviral naive at HAART initiation. Different indicators of treatment failure were defined: immunological failure (absence of an increase of 100 CD4 cells/microl or more); immunovirological failure (CD4 cell count of 200 cells/microl or less and detectable HIV-RNA); clinical failure (occurrence of an AIDS-defining illness more than 3 months after HAART initiation). Differences in the frequency of treatment failure were measured using logistic regression models adjusted for major established determinants of response to HAART.


RESULTS
Overall, 19.6% of the study participants experienced immunological failure, 3.4% immunovirological failure, and 3.0% clinical failure, with substantial variations across the various subgroups. Compared with homo/bisexual men, migrants had higher rates of immunological failure (adjusted odds ratio 2.27, 95% confidence interval 1.14-4.56 for migrant men and 2.19, 1.17-4.08 for migrant women), immunovirological failure (8.23, 1.77-38.33 and 6.91, 1.03-46.32), and clinical failure (4.60, 1.01-20.86 and 4.22, 0.84-21.17).


CONCLUSIONS
In France, migrants consistently appear to be at increased risk of treatment failure compared with other people with HIV. Understanding the reasons underlying such heterogeneity in terms of living conditions and educational/cultural background will be important.
Dray-Spira
Rosemary
R
INSERM, U687, Saint-Maurice, and Université Paris XI, IFR69, Villejuif, and Hôpital Européen Georges Pompidou, Service d'immunologie clinique, Paris, France. rosemary.dray-spira@st-maurice.inserm.fr
Spire
Bruno
B
Heard
Isabelle
I
Lert
France
F
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014171:Transients and Migrants; D017211:Treatment Failure; D019562:Viral Load
D019380:Anti-HIV Agents