Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France

Autor:	Tania Kandel, Imad Kansau, Carole Pignon, Patricia Honoré, François Boué, Céline Michaud, Marion Favier, Sophie Abgrall, Mariem Raho-Moussa, Olivier Bouchaud, Naomi L. Sayre, Véronique Chambrin, Elsa Miekoutima, Marguerite Guiguet, Christia Palacios, Michka Shoai, Mohammed Azghay
Přispěvatelé:	Hôpital Antoine Béclère, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris 13 (UP13), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Jazyk:	angličtina
Rok vydání:	2019
Předmět:	Male RNA viruses 0301 basic medicine Sustained Virologic Response Social Determinants of Health Economics Cross-sectional study Social Sciences HIV Infections Pathology and Laboratory Medicine Toxicology Geographical locations 0302 clinical medicine Immunodeficiency Viruses [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases Medicine and Health Sciences Outpatient clinic Medicine Public and Occupational Health 030212 general & internal medicine 10. No inequality Transients and Migrants Human Capital Multidisciplinary Middle Aged Viral Load Vaccination and Immunization Socioeconomic Aspects of Health Europe Cultural deprivation Social deprivation Medical Microbiology Viral Pathogens Viruses Female France Pathogens Economics of Migration Viral load Research Article Adult Paris Anti-HIV Agents Science Immunology Psychosocial Deprivation Antiretroviral Therapy Microbiology 03 medical and health sciences Antiviral Therapy Acquired immunodeficiency syndrome (AIDS) Virology Retroviruses Humans European Union Social determinants of health Microbial Pathogens Toxicity business.industry Lentivirus Organisms HIV Biology and Life Sciences Odds ratio medicine.disease 030112 virology Health Care Cross-Sectional Studies Socioeconomic Factors Cultural Deprivation [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie Preventive Medicine People and places business Finance Viral Transmission and Infection Demography
Zdroj:	PLoS ONE, Vol 14, Iss 3, p e0213019 (2019) PLoS ONE PLoS ONE, Public Library of Science, 2019, 14 (3), pp.e0213019. ⟨10.1371/journal.pone.0213019⟩
ISSN:	1932-6203
DOI:	10.1371/journal.pone.0213019⟩
Popis:	International audience; Barriers to achieve sustained HIV virological suppression on antiretroviral therapy (ART) jeopardize the success of the 90:90:90 UNAIDS initiative which aims to end the HIV/AIDS epidemic. In France, where access to ART is free and universally available, we analyze the way in which social determinants of health (i.e. cultural, environmental) and economic factors might influence virological outcomes. A cross-sectional study was performed in two hospitals located in Paris area. All consecutive people living with HIV (PLHIV) on ART for at least 6 months attending the outpatient clinics between 01/05/2013 and 31/10/2014 answered an individual score of deprivation, EPICES, retrieving information on health insurance status, economic status, family support and leisure activity. This score varies from 0 to 100 with deprivation state defined above 30.17. Factors associated with HIV viral load >50 copies/ml were assessed by logistic regression modeling with a backward stepwise selection to select the final multivariable model. Sensitivity analyses were performed using two other thresholds for virological non-suppression (100 or 200 copies/ml). Overall, 475 PLHIV were included (53% male, median age 47 years, 66% not born in France mainly in a sub-Saharan African country). Half of French natives and 85% of migrants were classified as deprived. Median duration on ART was 9.7 years with virological suppression in 95.2% of non-deprived participants and in 83.5% of deprived ones (p = 0.001). The final multivariable model retained ART tiredness, younger age, a previous AIDS event and social deprivation (adjusted Odds Ratio, 2.9; 95%CI, 1.2-7.0) as determinants of virological non-suppression but not migration in itself. When using separate components of EPICES score, reporting economic difficulties and non-homeownership were associated with virological non-suppression. In addition to interventions focusing on cultural aspects of migration, social interventions are needed to help people with social vulnerability to obtain sustained responses on ART.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::debfdb6903ac29d65d7cfed601fc8239 https://doaj.org/article/1cbca1debf454fc595158e1893a12eed Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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