Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives: Data from the ICONA cohort

Clinical Microbiology and Infection
Volume 22, Issue 3, 2016, Pages 288.e1-288.e8

Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives: Data from the ICONA cohort (Article) (Open Access)

Saracino A.* , Lorenzini P. , Lo Caputo S. , Girardi E. , Castelli F. , Bonfanti P. , Rusconi S. , Caramello P. , Abrescia N. , Mussini C. , Monno L. , d'Arminio Monforte A. , Moroni M. , Andreoni M. , Angarano G. , Antinori A. , Cauda R. , Di Perri G. , Galli M. , Iardino R. , Ippolito G. , Lazzarin A. , Perno C.F. , von Schloesser F. , Viale P. , Castagna A. , Cozzi-Lepri A. , Puoti M. , Ammassari A. , Balotta C. , Bonora S. , Borderi M. , Capobianchi M.R. , Ceccherini-Silberstein F. , Cingolani A. , Cinque P. , De Luca A. , Di Biagio A. , Gianotti N. , Gori A. , Guaraldi G. , Lapadula G. , Lichtner M. , Madeddu G. , Maggiolo F. , Marchetti G. , Marcotullio S. , Quiros Roldan E. , Cicconi P. , Fanti I. , Galli L. , Shanyinda M. , Tavelli A. , Giacometti A. , Costantini A. , Mazzoccato S. , Santoro C. , Suardi C. , Vanino E. , Verucchi G. , Minardi C. , Quirino T. , Abeli C. , Manconi P.E. , Piano P. , Vecchiet J. , Falasca K. , Sighinolfi L. , Segala D. , Mazzotta F. , Cassola G. , Viscoli C. , Alessandrini A. , Piscopo R. , Mazzarello G. , Mastroianni C. , Belvisi V. , Caramma I. , Chiodera A. , Castelli A.P. , Rizzardini G. , Ridolfo A.L. , Piolini R. , Salpietro S. , Carenzi L. , Moioli M.C. , Tincati C. , Puzzolante C. , Chirianni A. , Borgia G. , Guida M.G. , Gargiulo M. , Gentile I. , Orlando R. , Baldelli F. , Francisci D. , Parruti G. , Ursini T. , Magnani G. , Ursitti M.A. , Vullo V. , d'Avino A. , Gallo L. , Nicastri E. , Acinapura R. , Capozzi M. , Libertone R. , Tebano 1G. , Zaccarelli M. , Viviani F. , Sasset L. , Mura M.S. , Rossetti B. , Orofino G.C. , Sciandra M. , Bassetti M. , Londero A. , Pellizzer G. , Manfrin V.

^a Clinic of Infectious Diseases, University of Bari, Bari, Italy
^b Clinical Department, National Inst. for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
^c Santissima Annunziata Hospital, Firenze, Italy, Firenze, Italy
^d Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani, IRCCS, Rome, Italy
^e University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy, Brescia, Italy
^f Department of Infectious Diseases, Azienda Ospedaliera Lecco, Lecco, Italy, Lecco, Italy
^g Department of Infectious Disease, L. Sacco University Hospital, University of Milan, Milan, Italy
^h Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy, Torino, Italy
ⁱ Department of Infectious Diseases, Cotugno Hospital, Naples, Italy, Napoli, Italy
^j Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
^k Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy, Bari, Italy
^l Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy, Milano, Italy
^m [Affiliation not available]
ⁿ Roma, Italy
^o Bari, Italy
^p Roma, Italy
^q Roma, Italy
^r Torino, Italy
^s Milano, Italy
^t [Affiliation not available]
^u [Affiliation not available]
^v Milano, Italy
^w [Affiliation not available]
^x [Affiliation not available]
^y Bologna, Italy
^z Milano, Italy
^a [Affiliation not available]
^b Milano, Italy
^c [Affiliation not available]
^d [Affiliation not available]
^e Torino, Italy
^f [Affiliation not available]
^g [Affiliation not available]
^h [Affiliation not available]
ⁱ Roma, Italy
^j [Affiliation not available]
^k Siena, Italy
^l [Affiliation not available]
^m [Affiliation not available]
ⁿ Monza, Italy
^o [Affiliation not available]
^p Monza, Italy
^q [Affiliation not available]
^r Sassari, Italy
^s Bergamo, Italy
^t Milano, Italy
^u [Affiliation not available]
^v Brescia, Italy
^w [Affiliation not available]
^x [Affiliation not available]
^y [Affiliation not available]
^z [Affiliation not available]
^a [Affiliation not available]
^b Ancona, Italy
^c Ancona, Italy
^d Ancona, Italy
^e Bari, Italy
^f Bergamo, Italy
^g Bologna, Italy
^h Bologna, Italy
ⁱ Brescia, Italy
^j Busto Arsizio, Italy
^k Busto Arsizio, Italy
^l Cagliari, Italy
^m Cagliari, Italy
ⁿ Chieti, Italy
^o Chieti, Italy
^p Ferrara, Italy
^q Ferrara, Italy
^r Firenze, Italy
^s Genova, Italy
^t Genova, Italy
^u Genova, Italy
^v Genova, Italy
^w Genova, Italy
^x Latina, Italy
^y Latina, Italy
^z Lecco, Italy
^a Macerata, Italy
^b Macerata, Italy
^c Milano, Italy
^d Milano, Italy
^e Milano, Italy
^f Milano, Italy
^g Milano, Italy
^h Milano, Italy
ⁱ Milano, Italy
^j Modena, Italy
^k Napoli, Italy
^l Napoli, Italy
^m Napoli, Italy
ⁿ Napoli, Italy
^o Napoli, Italy
^p Napoli, Italy
^q Perugia, Italy
^r Perugia, Italy
^s Pescara, Italy
^t Pescara, Italy
^u Reggio Emilia, Italy
^v Reggio Emilia, Italy
^w Roma, Italy
^x Roma, Italy
^y Roma, Italy
^z Roma, Italy
^a Roma, Italy
^b Roma, Italy
^c Roma, Italy
^d Roma, Italy
^e Roma, Italy
^f Rovigo, Italy
^g Rovigo, Italy
^h Sassari, Italy
ⁱ Siena, Italy
^j Torino, Italy
^k Torino, Italy
^l Udine, Italy
^m Udine, Italy
ⁿ Vicenza, Italy
^o Vicenza, Italy

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. © 2015 European Society of Clinical Microbiology and Infectious Diseases.

Author Keywords

Migrants Antiretroviral therapy HIV ICONA Virologic failure

Index Keywords

unemployment HIV Infections Kaplan-Meier Estimate multicenter study Human immunodeficiency virus infection clinical trial indigenous people risk drug treatment failure human highly active antiretroviral therapy comorbidity middle aged Antiretroviral Therapy, Highly Active Viral Load risk assessment Human immunodeficiency virus infected patient priority journal antiretrovirus agent Treatment Failure migrant Humans virology Treatment Outcome male CD4 lymphocyte count female Article major clinical study adult migration HIV-1 health care access virus load age distribution cohort analysis proteinase inhibitor Italy Human immunodeficiency virus 1 Transients and Migrants nonnucleoside reverse transcriptase inhibitor virologic failure microbiological parameters disease association acquired immune deficiency syndrome health care disparity Kaplan Meier method anti human immunodeficiency virus agent Anti-HIV Agents

Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84959310533&doi=10.1016%2fj.cmi.2015.10.026&partnerID=40&md5=43b7815bf3b9a9ec10ee72cd042382a1

DOI: 10.1016/j.cmi.2015.10.026

ISSN: 1198743X

Cited by: 13

Original Language: English