Timing of cART initiation in male and female migrants living with HIV in Western Europe: an observational cohort study (1997-2013).    AIDS

The Migrant Health Working Group on behalf of COHERE in EuroCoord aimed to evaluate differences in timing of combined antiretroviral treatment (cART) initiation by geographical origin in male and female HIV-positive patients in COHERE. They included 151 674 individuals (72.9% men) from Western Europe between January 1997 and March 2013, with known geographical origin and at least 1 CD4+ cell count measurement while cART-naïve.

Median CD4+ cell count falls far below 250 cells/ml in all groups and was lowest in sub-Saharan African (SSA: 161), Caribbean men (161) and in Asian women (185). Among men, the adjusted probability of cART initiation was lower in migrants compared with natives, but differences depended on initial CD4+ cell count. In women, no meaningful differences were observed between natives and most migrant groups. However, SSA women had a 31% higher probability of cART initiation when recruited at a CD4+ more than 500 cells/ml and 9% (4–14%) lower when recruited at CD4+ less than 100 cells/ml.

In conclusion, the study-results highlight late initiation of cART in the migrant population in Western Europe and differences in timing of cART initiation for some groups within migrant communities, especially for men. Addressing existing barriers to access HIV testing and care and ensuring universal and free access to cART is important to advance in the elimination of inequities and in the control of the HIV epidemic in Western Europe.

PubMed