Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis.
OBJECTIVE
In lower-income countries rates of AIDS-defining events (ADEs) and death are high during the first year of combination antiretroviral therapy (ART). We investigated differences between foreign-born (migrant) and native-born (nonmigrant) patients initiating ART in Europe, the US and Canada, and examined rates of the most common ADEs and mortality during the first year of ART.


METHODS
Observational cohort study.


METHODS
We studied HIV-positive adults participating in one of 12 cohorts in the Antiretroviral Therapy Cohort Collaboration (ART-CC).


RESULTS
Of 48 854 patients, 25.6% were migrants: 16.1% from sub-Saharan Africa, 5.6% Latin America, 2.3% North Africa/Middle East, and 1.6% Asia. Incidence of ADEs during the first year of ART was 60.8 per 1000 person-years: 69.9 for migrants and 57.7 for nonmigrants [crude hazard ratio (HR) 1.18; 95% confidence interval (CI) 1.08-1.29], adjusted HR (for sex, age, CD4, HIV-1 RNA, ART regimen, prior ADE, probable route of infection and year of initiation, and stratified by cohort) 1.21 (95% CI 1.09-1.34). Rates of tuberculosis were substantially higher in migrants than nonmigrants (14.3 vs. 6.3; adjusted HR 1.94; 95% CI 1.53-2.46). In contrast, mortality was higher among nonmigrants than migrants (crude HR 0.71; 95% CI 0.61-0.84), although excess mortality was partially explained by patient characteristics at start of ART (adjusted HR 0.91; 95% CI 0.76-1.09).


CONCLUSIONS
During the first year of ART, HIV-positive migrants had higher rates of ADEs than nonmigrants. Tuberculosis was the most common ADE among migrants, highlighting the importance of screening for tuberculosis prior to ART initiation in this population.
Bryan E
BE
Shepherd
Cathy A
CA
Jenkins
Deidra D
DD
Parrish
Tracy R
TR
Glass
Angela
A
Cescon
Angels
A
Masabeu
Genevieve
G
Chene
Frank
F
de Wolf
Heidi M
HM
Crane
Inma
I
Jarrin
John
J
Gill
Julia
J
del Amo
Sophie
S
Abgrall
Pavel
P
Khaykin
Clara
C
Lehmann
Suzanne M
SM
Ingle
Margaret T
MT
May
Jonathan A C
JA
Sterne
Timothy R
TR
Sterling
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
D019380:Anti-HIV Agents