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.
Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives : Data from the ICONA cohort / P. Lorenzini, S. Lo Caputo, E. Girardi, F. Castelli, P. Bonfanti, S. Rusconi, P. Caramello, N. Abrescia, C. Mussini, L. Monno, A. d'Arminio Monforte, M. Moroni, M. Andreoni, G. Angarano, A. Antinori, A. d’Arminio Monforte, F. Castelli, R. Cauda, G. Di Perri, M. Galli, R. Iardino, G. Ippolito, A. Lazzarin, C.F. Perno, F. von Schloesser, P. Viale, A. Castagna, F. Ceccherini Silberstein, A. Cozzi Lepri, E. Girardi, S. Lo Caputo, C. Mussini, M. Puoti, A. Ammassari, C. Balotta, P. Bonfanti, S. Bonora, M. Borderi, M.R. Capobianchi, A. Cingolani, P. Cinque, A. De Luca, A. Di Biagio, N. Gianotti, A. Gori, G. Guaraldi, G. Lapadula, M. Lichtner, G. Madeddu, F. Maggiolo, G. Marchetti, S. Marcotullio, L. Monno, E. Quiros Roldan, S. Rusconi, A. Saracino, P. Cicconi, I. Fanti, L. Galli, P. Lorenzini, M. Shanyinda, A. Tavelli, A. Giacometti, A. Costantini, S. Mazzoccato, C. Santoro, C. Suardi, E. Vanino, G. Verucchi, C. Minardi, T. Quirino, C. Abeli, P.E. Manconi, P. Piano, J. Vecchiet, K. Falasca, L. Sighinolfi, D. Segala, F. Mazzotta, G. Cassola, C. Viscoli, A. Alessandrini, R. Piscopo, G. Mazzarello, C. Mastroianni, V. Belvisi, I. Caramma, A. Chiodera, A.P. Castelli, G. Rizzardini, A.L. Ridolfo, R. Piolini, S. Salpietro, L. Carenzi, M.C. Moioli, C. Tincati, C. Puzzolante, N. Abrescia, A. Chirianni, G. Borgia, M.G. Guida, M. Gargiulo, I. Gentile, R. Orlando, F. Baldelli, D. Francisci, G. Parruti, T. Ursini, G. Magnani, M.A. Ursitti, V. Vullo, A. D’Avino, L. Gallo, E. Nicastri, R. Acinapura, M. Capozzi, R. Libertone, G. Tebano, M. Zaccarelli, F. Viviani, L. Sasset, M.S. Mura, B. Rossetti, P. Caramello, G. Di Perri, G.C. Orofino, M. Sciandra, M. Bassetti, A. Londero, G. Pellizzer, V. Manfrin. - In: CLINICAL MICROBIOLOGY AND INFECTION. - ISSN 1198-743X. - 22:3(2016 Mar), pp. 288.e1-288.e8. [10.1016/j.cmi.2015.10.026]
Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives : Data from the ICONA cohort
S. Rusconi;A. d'Arminio MonforteUltimo
;M. Galli;C.F. Perno;C. Balotta;A. Gori;G. Marchetti;C. Tincati;
2016
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.
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