title: Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives: data from the ICONA cohort.
abstract: Migrant and Italian HIV-infected patients (n = 5773) enrolled in the ICONA cohort in 2004-2014 were compared for disparities in access to an initial antiretroviral regimen and/or risk of virologic failure (VF), and determinants of failure were evaluated. Variables associated with initiating antiretroviral therapy (ART) were analysed. Primary endpoint was time to failure after at least 6 months of ART and was defined as: VF, first of two consecutive virus loads (VL) >200 copies/mL; treatment discontinuation (TD) for any reason; and treatment failure as confirmed VL >200 copies/mL or TD. A Poisson multivariable analysis was performed to control for confounders. Migrants presented significantly lower CD4 counts and more frequent AIDS events at baseline. When adjusting for baseline confounders, migrants presented a lower likelihood to begin ART (odds ratio 0.80, 95% confidence interval (CI) 0.67-0.95, p 0.012). After initiating ART, the incidence VF rate was 6.4 per 100 person-years (95% CI 4.8-8.5) in migrants and 2.7 in natives (95% CI 2.2-3.3). Multivariable analysis confirmed that migrants had a higher risk of VF (incidence rate ratio 1.90, 95% CI 1.25-2.91, p 0.003) and treatment failure (incidence rate ratio 1.16, 95% CI 1.01-1.33, p 0.031), with no differences for TD. Among migrants, variables associated with VF were age, unemployment and use of a boosted protease inhibitor-based regimen versus nonnucleoside reverse transcriptase inhibitors. Despite the use of more potent and safer drugs in the last 10 years, and even in a universal health care setting, migrants living with HIV still present barriers to initiating ART and an increased risk of VF compared to natives.
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy. Electronic address: annalisa.saracino@uniba.it.
authors.forename: A
authors.initials: A
authors.lastname: Saracino
authors.affiliation: Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Lorenzini
authors.affiliation: Santissima Annunziata Hospital, Firenze, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Lo Caputo
authors.affiliation: Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani,' IRCCS, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Girardi
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Castelli
authors.affiliation: Department of Infectious Diseases, Azienda Ospedaliera Lecco, Lecco, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bonfanti
authors.affiliation: Department of Infectious Disease, L. Sacco University Hospital, University of Milan, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Rusconi
authors.affiliation: Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Caramello
authors.affiliation: Department of Infectious Diseases, Cotugno Hospital, Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Abrescia
authors.affiliation: Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mussini
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Monno
authors.affiliation: Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: d'Arminio Monforte
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012306:Risk; D014171:Transients and Migrants; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; HIV; ICONA; migrants; virologic failure