title: CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care-a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999-2013.
abstract: Although early presentation to HIV-care is essential to ensure timely initiation of antiretroviral therapy, recent studies have shown that especially migrants present to HIV-care at a later stage of HIV-infection. Currently, thirty percent of all newly diagnosed HIV cases in Germany originate from abroad. So far it is unknown, which specific migrant groups in Germany are particularly at risk for late presentation to HIV-care.
  
  
  
  We used data from the Clinical Surveillance of HIV Disease (ClinSurv) cohort, a multi-centre observational cohort (01/01/1999 and 31/07/2013) and included treatment-naïve patients with valid information on country of origin and date of enrolment. Migrants were patients with country of origin outside Germany. We compared time trends for percentage of AIDS (CDC Stage C) and mean CD4-count at enrolment between migrants from Western Europe (WE), Central Europe (CE), Eastern Europe (EE), Sub-Saharan Africa (SSA), South East Asia (SEA) and non-migrants using multivariable regressions. Male non-migrants with mean age of 38-years constituted the reference group.
  
  
  
  In total, 10,211 patients fulfilled the inclusion criteria, of which 2784 were migrants (SSA: 42%, CE: 17%, WE: 11%, EE: 10%, SEA: 9%). The percentage of patients with AIDS at enrolment was higher in SSA (Odds Ratio (OR)SSA: 1.44, 95%-confidence interval (95%-CI):1.12-1.84) and SEA-migrants (ORSEA:2.16, 95%-CI:1.43-3.27). In addition, female SEA-migrants, were more likely to present with AIDS than their male counterparts (OR:2.22, 95%-CI:1.18-4.17). Mean CD4-count at enrolment was lower for SSA- (Mean CD4-count ratio (IRR):0.72; 95%-CI:0.64-0.82) and SEA-migrants (IRR:0.62, 95%-CI:0.49-0.78). Over time, it increased in non-migrants and CE-migrants (by 1 and 3%/year, respectively), whereas no increase was seen for SEA and SSA.
  
  
  
  SSA and SEA-migrants in Germany present to HIV-care at a later stage of HIV infection than non-migrants. Additionally, previous research found a higher risk for late HIV-testing for migrants. Collecting information about the arrival date of migrants in Germany in the HIV notification system would help to understand to which extent these problems could be tackled in Germany. Moreover, participatory approaches for HIV-testing and care as well as research regarding knowledge, behaviour and attitudes towards these topics for SSA and SEA migrants should be expanded.
authors.affiliation: Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany. ZeitlmannN@rki.de.|European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden. ZeitlmannN@rki.de.|Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. ZeitlmannN@rki.de.|Department for Infectious Disease Epidemiology, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany. ZeitlmannN@rki.de.
authors.forename: Nadine
authors.initials: N
authors.lastname: Zeitlmann
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gunsenheimer-Bartmeyer
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Santos-Hövener
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kollan
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: An der Heiden
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005858:Germany / Q000453:epidemiology / Q000208:ethnology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014171:Transients and Migrants / Q000706:statistics & numerical data
keywords: AIDS; CD4; Care; Germany; HIV; Late presentation; Migrants; South-East Asia; Sub-Saharan Africa