title: Inequalities in HIV disease management and progression in migrants from Latin America and sub-Saharan Africa living in Spain.
abstract: OBJECTIVE
  The objective of the study was to analyse key HIV-related outcomes in migrants originating from Latin America and the Spanish-speaking Caribbean (LAC) or sub-Saharan Africa (SSA) living in Spain compared with native Spaniards (NSP).
  
  
  METHODS
  The Cohort of the Spanish AIDS Research Network (CoRIS) is an open, prospective, multicentre cohort of antiretroviral-naïve patients representing 13 of the 17 Spanish regions. The study period was 2004-2010. Multivariate logistic or Fine and Gray regression models were fitted as appropriate to estimate the adjusted effect of region of origin on the different outcomes.
  
  
  RESULTS
  Of the 6811 subjects in CoRIS, 6278 were NSP (74.2%), LAC (19.4%) or SSA (6.4%). For these patients, the follow-up time was 15870 person-years. Compared with NSP, SSA and LAC under 35 years of age had a higher risk of delayed diagnosis [odds ratio (OR) 2.0 (95% confidence interval (CI) 1.5-2.8) and OR 1.7 (95% CI 1.4-2.1), respectively], as did LAC aged 35-50 years [OR 1.3 (95% CI 1.0-1.6)]. There were no major differences in time to antiretroviral therapy (ART) requirement or initiation. SSA exhibited a poorer immunological and virological response [hazard ratio (HR) [corrected] 0.8 (95% CI 0.7-1.0) and HR [corrected] 0.7 (95% CI 0.6-0.9), respectively], while no difference was found for LAC. SSA and LAC showed an increased risk of AIDS for ages between 35 and 50 years [HR 2.0 (95% CI 1.1-3.7) and HR [corrected] 1.6 (95% CI 1.1-2.4), respectively], which was attributable to a higher incidence of tuberculosis. However, no statistically significant differences were observed in mortality.
  
  
  CONCLUSIONS
  Migrants experience a disproportionate diagnostic delay, but no meaningful inequalities were identified regarding initiation of treatment after diagnosis. A poorer virological and immunological response was observed in SSA. Migrants had an increased risk of AIDS, which was mainly attributable to tuberculosis.
authors.affiliation: AIDS Research Network, National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain. smonge@isciii.es
authors.forename: S
authors.initials: S
authors.lastname: Monge
authors.forename: B
authors.initials: B
authors.lastname: Alejos
authors.forename: F
authors.initials: F
authors.lastname: Dronda
authors.forename: J
authors.initials: J
authors.lastname: Del Romero
authors.forename: J A
authors.initials: JA
authors.lastname: Iribarren
authors.forename: F
authors.initials: F
authors.lastname: Pulido
authors.forename: R
authors.initials: R
authors.lastname: Rubio
authors.forename: J M
authors.initials: JM
authors.lastname: Miró
authors.forename: F
authors.initials: F
authors.lastname: Gutierrez
authors.forename: J
authors.initials: J
authors.lastname: Del Amo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D003695:Delivery of Health Care; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D014171:Transients and Migrants; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents