TY - JOUR
TI - Timing of combined antiretroviral treatment initiation in male and female migrants living with HIV in Western Europe
AU - Monge, S.
AU - Jarrín, I.
AU - Pantazis, N.
AU - Mocroft, A.
AU - Sabin, C.A.
AU - Touloumi, G.
AU - van Sighem, A.
AU - Abgrall, S.
AU - Dray-Spira, R.
AU - Spire, B.
AU - Castagna, A.
AU - Mussini, C.
AU - Zangerle, R.
AU - Hessamfar, M.
AU - Anderson, J.
AU - Hamouda, O.
AU - Ehren, K.
AU - Obel, N.
AU - Kirk, O.
AU - de Monteynard, L.A.
AU - Antinori, A.
AU - Girardi, E.
AU - Saracino, A.
AU - Calmy, A.
AU - de Wit, S.
AU - Wittkop, L.
AU - Bucher, H.C.
AU - Montoliu, A.
AU - Raben, D.
AU - Prins, M.
AU - Meyer, L.
AU - Chene, G.
AU - Burns, F.
AU - Del Amo, J.
AU - The Migrant Health Working Group for the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord
JO - Ελληνικά Αρχεία AIDS=:  Hellenic Archives of AIDS
PY - 2017
VL - 31
TODO - 6
SP - 835-846
PB - Lippincott Williams and Wilkins
SN - 11058900
TODO - 10.1097/QAD.0000000000001411
TODO - anti human immunodeficiency virus agent;  antiretrovirus agent, adult;  antiretroviral therapy;  Article;  CD4 lymphocyte count;  clinical outcome;  cohort analysis;  female;  human;  Human immunodeficiency virus infected patient;  Human immunodeficiency virus infection;  indigenous people;  major clinical study;  male;  migrant;  priority journal;  sex difference;  time to treatment;  Western Europe;  Europe;  Human immunodeficiency virus infection;  migration;  time, Anti-Retroviral Agents;  CD4 Lymphocyte Count;  Europe;  Female;  HIV Infections;  Humans;  Male;  Time;  Transients and Migrants
TODO - Background: We evaluate differences in timing of cART (combined antiretroviral treatment) initiation by geographical origin in male and female HIV-positive patients in the Collaboration of Observational HIV Epidemiological Research Europe, a large European Collaboration of HIV Cohorts. Methods: We included individuals recruited in Western Europe between January 1997 and March 2013, with known geographical origin and at least 1 CD4þ cell count measurement while cART-naive. Timing of cART was assessed through modified time-to-event methods, in which a scale of CD4þ cell counts was used instead of time, with cART being the outcome. We estimated the median CD4þ cell count at cART initiation (estimated CD4þ levels at which the probability of having started cART is 50%) using Kaplan-Meier and adjusted hazard ratios of cART initiation using Cox regression. Results: Of 151 674 individuals, 110 592 (72.9%) were men. Median (95% confidence interval) CD4þ cell count falls far below 250 cells/ml in all groups and was lowest in sub-Saharan African [SSA: 161 (158-167)], Caribbean men [161 (150-174)] and in Asian women [Asian Continent and Oceania: 185 (165-197)]. Among men, the adjusted probability of cART initiation was lower in migrants compared with natives, but differences depended on initial CD4þ cell count. For example, in the group with more than 500 CD4þ at recruitment, they were 45% (36-53%), 30% (17-40%) and 25% (19-30%) lower for Caribbean, Eastern European and SSA men, respectively. In women, no meaningful differences were observed between natives and most migrant groups. However, SSA women had a 31% (24-38%) higher probability of cART initiation when recruited at a CD4þ more than 500 cells/ml and 9% (4-14%) lower when recruited at CD4þ less than 100 cells/ml. Conclusion: Most migrant men initiate cART at lower CD4þ cell count than natives, whereas this does not hold for migrant women. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ER -