title: Do HIV-Infected Immigrants Initiating HAART have Poorer Treatment-Related Outcomes than Autochthonous Patients in Spain? Results of the GESIDA 5808 Study.
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 naïve 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-naïve 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 Log(10) vs. 4.98 Log(10)), 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.
authors.affiliation: Tropical Medicine Unit, Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9,100, Madrid 28034, Spain. jose.perezmolina@gmail.com
authors.forename: José A
authors.initials: JA
authors.lastname: Pérez Molina
authors.forename: Marta Mora
authors.initials: MM
authors.lastname: Rillo
authors.forename: Ignacio
authors.initials: I
authors.lastname: Suárez-Lozano
authors.forename: Jose L
authors.initials: JL
authors.lastname: Casado Osorio
authors.forename: Ramón Teira
authors.initials: RT
authors.lastname: Cobo
authors.forename: Pablo Rivas
authors.initials: PR
authors.lastname: González
authors.forename: Enric Pedrol
authors.initials: EP
authors.lastname: Clotet
authors.forename: Asunción Hernando
authors.initials: AH
authors.lastname: Jerez
authors.forename: Pere Domingo
authors.initials: PD
authors.lastname: Pedrol
authors.forename: Ana
authors.initials: A
authors.lastname: Royuela
authors.forename: Elena Barquilla
authors.initials: EB
authors.lastname: Díaz
authors.forename: Herminia
authors.initials: H
authors.lastname: Esteban
authors.forename: Juan
authors.initials: J
authors.lastname: González-García
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D054242:Emigrants and Immigrants; D023381:Endpoint Determination; D005006:Ethnicity; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents