Monge, S;
Jarrin, I;
Pantazis, N;
Mocroft, A;
Sabin, CA;
Touloumi, G;
van Sighem, A;
... Del Amo, J; + view all
(2017)
Timing of combined antiretroviral treatment initiation in male and female migrants living with HIV in Western Europe.
AIDS
, 31
(6)
pp. 835-846.
10.1097/QAD.0000000000001411.
Preview |
Text
Mocroft_Abstract-R1.pdf - Accepted Version Download (183kB) | Preview |
Preview |
Text
Mocroft_MAIN TEXT-R1.pdf - Accepted Version Download (378kB) | Preview |
Preview |
Text
Mocroft_Figures-R1.pdf - Accepted Version Download (238kB) | Preview |
Preview |
Text
Mocroft_Tables-R1.pdf - Accepted Version Download (334kB) | Preview |
Preview |
Text
Mocroft_SUPLEMENTARY TABLE-R1.pdf - Accepted Version Download (418kB) | Preview |
Abstract
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. AIMS: METHODS: We included individuals recruited in Western Europe between January 1997 and March 2013, with known geographical origin and at least 1 CD4+ cell count measurement while cART-naive. Timing of cART was assessed through modified time-to-event methods, in which a scale of CD4+ cell counts was used instead of time, with cART being the outcome. We estimated the median CD4+ cell count at cART initiation (estimated CD4+ 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) CD4+ cell count falls far below 250 cells/µl 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 CD4+ cell count. For example, in the group with more than 500 CD4+ 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 CD4+ more than 500 cells/µl and 9% (4–14%) lower when recruited at CD4+ less than 100 cells/µl. CONCLUSIONS: Most migrant men initiate cART at lower CD4+ cell count than natives, whereas this does not hold for migrant women.
| Type: | Article |
|---|---|
| Title: | Timing of combined antiretroviral treatment initiation in male and female migrants living with HIV in Western Europe |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/QAD.0000000000001411 |
| Publisher version: | http://dx.doi.org/10.1097/QAD.0000000000001411 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, Virology, Access To Healthcare, Cohort Studies, Combined Antiretroviral Therapy, HIV, Migrants, Sub-Saharan Africa, Disease Progression, Base-Line, Follow-Up, Therapy, Cohort, Care, Immigrants, Access, Inequalities |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1549547 |
Archive Staff Only
 |
View Item |
