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

A. G. Saracino, Patrizia Lorenzini, S. Lo Caputo, Enrico Girardi, Francesco Castelli, P. Bonfanti, S. Rusconi, P. Caramello, N. Abrescia, Cristina Mussini, L. Monno, Antonella d'Arminio-Monforte, Marco Moroni, M. Andreoni, G. Angarano, A. Antinori, Antonella d'Arminio Monforte, F. Castelli, R. Cauda, G. Di PerriMassimo Galli, R. Iardino, Giuseppe Ippolito, A. Lazzarin, Carlo Federico Perno, F. Von Schloesser, P. Viale, A. D'Arminio Monforte, Andrea Antinori, Antonella Castagna, Francesca Ceccherini-Silberstein, A. Cozzi-Lepri, E. Girardi, S. Lo Caputo, C. Mussini, Massimo Puoti, Adriana Ammassari, A. Antinori, Claudia Balotta, Paolo Bonfanti, Stefano Bonora, M. Borderi, Maria Rosaria Capobianchi, Antonella Castagna, F. Ceccherini-Silberstein, Antonella Cingolani, Paola Cinque, A. Cozzi-Lepri, A. d'Arminio Monforte, Andrea De Luca, Antonio Di Biagio, E. Girardi, Nicola Gianotti, Andrea Gori, Giovanni Guaraldi, Giuseppe Lapadula, Miriam Lichtner, S. Lo Caputo, Giordano Madeddu, F. Maggiolo, G. Marchetti, Simone Marcotullio, L. Monno, C. Mussini, M. Puoti, E. Quiros-Roldan, S. Rusconi, A. Saracino, Alessandro Cozzi-Lepri, P. Cicconi, I. Fanti, Laura Galli, P. Lorenzini, M. Shanyinda, A. Tavelli, Andrea Giacometti, Andrea Costantini, S. Mazzoccato, G. Angarano, L. Monno, C. Santoro, F. Maggiolo, C. Suardi, P. Viale, E. Vanino, G. Verucchi, F. Castelli, E. Quiros Roldan, C. Minardi, T. Quirino, C. Abeli, P. E. Manconi, P. Piano, J. Vecchiet, K. Falasca, L. Sighinolfi, D. Segala, F. Mazzotta, S. Lo Caputo, Giovanni Cassola, Claudio Viscoli, A. Alessandrini, R. Piscopo, G. Mazzarello, C. Mastroianni, V. Belvisi, Paolo Bonfanti, I. Caramma, A. Chiodera, A. P. Castelli, Massimo Galli, Adriano Lazzarin, G. Rizzardini, M. Puoti, Antonella d'Arminio Monforte, A. L. Ridolfo, R. Piolini, Antonella Castagna, S. Salpietro, L. Carenzi, M. C. Moioli, C. Tincati, G. Marchetti, Cristina Mussini, C. Puzzolante, Andrea Gori, Giovanni Lapadula, N. Abrescia, Antonio Chirianni, G. Borgia, M. G. Guida, M. Gargiulo, Ivan Gentile, R. Orlando, F. Baldelli, D. Francisci, G. Parruti, T. Ursini, G. Magnani, M. A. Ursitti, R. Cauda, M. Andreoni, A. Antinori, Vincenzo Vullo, Antonella Cingolani, A. D'avino, L. Gallo, Emanuele Nicastri, Rosa Antonietta Acinapura, M. Capozzi, Raffaella Libertone, G. Tebano, Mauro Zaccarelli, F. Viviani, Lolita Sasset, M. S. Mura, Giordano Madeddu, A. De Luca, Barbara Rossetti, P. Caramello, Giovanni Di Perri, G. C. Orofino, S. Bonora, M. Sciandra, M. Bassetti, A. Londero, G. Pellizzer, Vinicio Manfrin

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)288.e1-288.e8
JournalClinical Microbiology and Infection
Volume22
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Keywords

  • Antiretroviral therapy
  • HIV
  • ICONA
  • Migrants
  • Virologic failure

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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