Later cART initiation in migrant men from sub-Saharan Africa without advanced HIV disease in France.
OBJECTIVE
To compare the time from entry into care for HIV infection until combination antiretroviral therapy (cART) initiation between migrants and non migrants in France, excluding late access to care.


METHODS
Antiretroviral-naïve HIV-1-infected individuals newly enrolled in the FHDH cohort between 2002-2010, with CD4 cell counts >200/μL and no previous or current AIDS events were included. In three baseline CD4 cell count strata (200-349, 350-499, ≥ 500/μL), we examined the crude time until cART initiation within three years after enrollment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrollment period, region of care, plasma viral load, and HBV/HBC coinfection.


RESULTS
Among 13338 individuals, 9605 (72.1%) were French natives (FRA), 2873 (21.4%) were migrants from sub-Saharan Africa/non-French West Indies (SSA/NFW), and 860 (6.5%) were migrants from other countries. Kaplan-Meier probabilities of cART initiation were significantly lower in SSA/NFW than in FRA individuals throughout the study period, regardless of the baseline CD4 stratum. After adjustment, the likelihood of cART initiation was respectively 15% (95%CI, 1-28) and 20% (95%CI, 2-38) lower in SSA/NFW men than in FRA men who had sex with men (MSM) in the 350-499 and ≥ 500 CD4 strata, while no difference was observed between other migrant groups and FRA MSM.


CONCLUSIONS
SSA/NFW migrant men living in France with CD4 >350/μL at entry into care are more likely to begin cART later than FRA MSM, despite free access to treatment. Administrative delays in obtaining healthcare coverage do not appear to be responsible.
Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
Laure-Amélie
LA
de Monteynard
Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
Rosemary
R
Dray-Spira
AP-HP, Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond-Poincaré, Département de Médecine Aigüe Spécialisée, Garches, France.
Pierre
P
de Truchis
INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris Descartes, Sorbonne Paris cité, Paris, France; AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Unité de Biostatistique et Epidémiologie, Paris, France.
Sophie
S
Grabar
Université Paris Descartes, Sorbonne Paris cité, Paris, France; AP-HP, Hôpital Cochin, Paris, France.
Odile
O
Launay
AP-HP, Hôpital Saint Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France.
Jean-Luc
JL
Meynard
Centre Hospitalier Saint-Denis, Hôpital Delafontaine, Service des Maladies Infectieuses et Tropicales, Saint-Denis, France.
Marie-Aude
MA
Khuong-Josses
AP-HP, Hôpital Hôtel-Dieu, Unité d'immunoinfectiologie, Paris, France.
Jacques
J
Gilquin
Hôpitaux Universitaire Strasbourg, Centre de Soins de l'Infection par le VIH, Strasbourg, France.
David
D
Rey
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de médecine interne, Paris, France.
Anne
A
Simon
AP-HP, Hôpital Européen Georges Pompidou, Service d'immunologie clinique, Paris, France.
Juliette
J
Pavie
Centre Hospitalier Andrée Rosemon, Service des Maladies Infectieuses et Tropicales, Cayenne, France.
Aba
A
Mahamat
Université Paris Diderot, Sorbonne Paris cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France.
Sophie
S
Matheron
Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
Dominique
D
Costagliola
Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France.
Sophie
S
Abgrall
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology / Q000821:virology; D015497:HIV-1 / Q000254:growth & development; D006509:Hepatitis B / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology / Q000821:virology; D006526:Hepatitis C / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology / Q000821:virology; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D061665:Time-to-Treatment; D014171:Transients and Migrants / Q000523:psychology; D019562:Viral Load
D019380:Anti-HIV Agents