Do HIV-Infected Immigrants Initiating HAART have Poorer Treatment-Related Outcomes than Autochthonous Patients in Spain? Results of the GESIDA 5808 Study.
| Autor: | Pérez Molina JA; Tropical Medicine Unit, Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9,100, Madrid 28034, Spain. jose.perezmolina@gmail.com, Rillo MM, Suárez-Lozano I, Casado Osorio JL, Cobo RT, González PR, Clotet EP, Jerez AH, Pedrol PD, Royuela A, Díaz EB, Esteban H, González-García J |
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| Jazyk: | angličtina |
| Zdroj: | Current HIV research [Curr HIV Res] 2010 Oct; Vol. 8 (7), pp. 521-30. |
| DOI: | 10.2174/157016210793499178 |
| Abstrakt: | Objective: currently, 12% of the Spanish population is foreign-born, and a third of newly diagnosed HIV-infected patients are immigrants. We determined whether being an immigrant was associated with a poorer response to antiretroviral treatment. Methods: historical multicenter cohort study of naïve patients starting HAART. The primary endpoint was time to treatment failure (TTF) defined as virological failure (VF), death, opportunistic disease, treatment discontinuation (D/C), or missing patient. Secondary endpoints were TTF expressed as observed data (TFO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/C not due to VF). A multivariate analysis was performed to control for confounders. Results: a total of 1090 treatment-naïve HIV-infected patients (387 immigrants and 703 autochthonous) from 33 hospitals were included. Most immigrants were from Sub-Saharan Africa (28.3%) or South-Central America/Caribbean (31%). Immigrants were significantly younger (34 y vs. 39 y), more frequently female (37.5% vs. 24.6%), with less HCV coinfection than autochthonous patients (7% vs. 31.3%). There were no differences in baseline viral load (4.95 Log(10) vs. 4.98 Log(10)), CD4 lymphocyte count (193.5/µL vs. 201.5/µL), late initiation of HAART (56.4% vs. 56.0%), or antiretrovirals used. Cox-regression analysis (HR; 95%CI) did not show differences in TTF (0.89; 0.66-1.20), TFO (0.95; 0.66-1.36), or TVF (1.00; 0.57-1.78) between immigrants and autochthonous patients. Losses to follow-up were more frequent among immigrants (17.8% vs. 12.1; p=0.009). Sub-Saharan African patients and immigrant females had a significantly shorter TTF. Conclusions: the response to HAART among immigrant patients was similar to that of autochthonous patients, although they had a higher rate of losses to follow-up. Sub-Saharan Africans and immigrant females may need particular measures to avoid barriers hindering antiviral efficacy. |
| Databáze: | MEDLINE |
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