title: Uptake of combination antiretroviral therapy and HIV disease progression according to geographical origin in seroconverters in Europe, Canada, and Australia.
abstract: BACKGROUND
  We examined differences by geographical origin (GO) in time from HIV seroconversion (SC) to AIDS, death, and initiation of antiretroviral therapy (cART).
  
  
  METHODS
  Data from HIV seroconverter cohorts in Europe, Australia and Canada (CASCADE) was used; GO was classified as: western countries (WE), North Africa and Middle East (NAME), sub-Saharan Africa (SSA), Latin America (LA), and Asia (ASIA). Differences by GO were assessed using Cox models. Administrative censoring date was 30 June 2008.
  
  
  RESULTS
  Of 16 941 seroconverters, 15 548 were from WE, 158 NAME, 762 SSA, 349 LA, and 124 ASIA. We found no differences by GO in risks of AIDS (P = .99) and death (P = .12), although seroconverters from NAME (adjusted hazard ratio [aHR]: 0.57; 95% CI: 0.33-.94) and SSA (aHR: 0.74; 95% CI: 0.50-1.10) appeared to have lower mortality than WE. Chances of initiating cART differed by GO (P < .001): seroconverters from SSA were more likely to initiate cART than WE (aHR: 1.48; 95% CI: 1.26-1.74), but not after adjustment for CD4 at SC (aHR: 1.11; 95% CI: 0.88-1.40).
  
  
  CONCLUSIONS
  In settings with universal access to healthcare, GO does not play a major role in HIV disease progression.
authors: National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. ijarrin@isciii.es
authors: Inma
authors: I
authors: Jarrin
authors: Nikos
authors: N
authors: Pantazis
authors: M John
authors: MJ
authors: Gill
authors: Ronald
authors: R
authors: Geskus
authors: Santiago
authors: S
authors: Perez-Hoyos
authors: Laurence
authors: L
authors: Meyer
authors: Maria
authors: M
authors: Prins
authors: Giota
authors: G
authors: Touloumi
authors: Anne
authors: A
authors: Johnson
authors: Osamah
authors: O
authors: Hamouda
authors: Patricia García
authors: PG
authors: de Olalla
authors: Kholoud
authors: K
authors: Porter
authors: Julia
authors: J
authors: del Amo
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents