PLoS ONE (Jan 2015)

Later cART initiation in migrant men from sub-Saharan Africa without advanced HIV disease in France.

  • Laure-Amélie de Monteynard,
  • Rosemary Dray-Spira,
  • Pierre de Truchis,
  • Sophie Grabar,
  • Odile Launay,
  • Jean-Luc Meynard,
  • Marie-Aude Khuong-Josses,
  • Jacques Gilquin,
  • David Rey,
  • Anne Simon,
  • Juliette Pavie,
  • Aba Mahamat,
  • Sophie Matheron,
  • Dominique Costagliola,
  • Sophie Abgrall,
  • French Hospital Database on HIV

DOI
https://doi.org/10.1371/journal.pone.0118492
Journal volume & issue
Vol. 10, no. 3
p. e0118492

Abstract

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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.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.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.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.