Mortality in migrants living with HIV in western Europe (1997-2013): A collaborative cohort study

Susana Monge, I. Jarrín, A. Mocroft, C. A. Sabin, Giota Touloumi, A. van Sighem, S. Abgrall, R. Dray-Spira, B. Spire, Antonella Castagna, Cristina Mussini, Robert Zangerle, M. Hessamfar, J. Anderson, Osamah Hamouda, K. Ehren, Niels Obel, Ole Kirk, L. A. de Monteynard, Andrea AntinoriE. Girardi, A. Saracino, A. Calmy, S. De Wit, Linda Wittkop, H. C. Bucher, A. Montoliu, Dorthe Raben, Maria Prins, Laurence Meyer, G. Chene, F. Burns, Josiane Warszawski, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Peter Reiss, Ferdinand Wit, Heiner Bucher, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Claire Thorne, Christoph Stephan, Santiago Pérez-Hoyos, Barbara Bartmeyer, Nikoloz Chkhartishvili, Antoni Noguera-Julian, Antonella d'Arminio Monforte, Norbert Brockmeyer, Luis Prieto, Pablo Rojo Conejo, Antoni Soriano-Arandes, Manuel Battegay, Roger Kouyos, Pat Tookey, Jordi Casabona, Jose M. Miró, Deborah Konopnick, Tessa Goetghebuer, Anders Sönnerborg, Carlo Torti, Caroline Sabin, Ramon Teira, Myriam Garrido, David Haerry, Stéphane de Wit, Dominique Costagliola, Geneviève Chêne, Diana Barger, Christine Schwimmer, Monique Termote, Maria Campbell, Casper M. Frederiksen, Nina Friis-Møller, Jesper Kjaer, Rikke Salbøl Brandt, Juan Berenguer, Julia Bohlius, Vincent Bouteloup, Alessandro Cozzi-Lepri, Mary Anne Davies, Julia del Amo, Maria Dorrucci, David Dunn, Matthias Egger, Hansjakob Furrer, Marguerite Guiguet, Sophie Grabar, Ali Judd, Olivier Lambotte, Valériane Leroy, Sara Lodi, Sophie Matheron, Fumiyo Nakagawa, Roger Paredes, Andrew Phillips, Massimo Puoti, Michael Schomaker, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Marc van der Valk, Natasha Wyss

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Many migrants face adverse socioeconomic conditions and barriers to health services that can impair timely HIV diagnosis and access to life-saving treatments. We aimed to assess the differences in overall mortality by geographical origin in HIV-positive men and women using data from COHERE, a large European collaboration of HIV cohorts from 1997 to 2013. Methods: In this observational cohort study, we included HIV-positive, antiretroviral-naive people accessing care in western Europe from COHERE. Individuals were eligible if enrolled in a cohort that collected information on geographical origin or ethnic origin from Jan 1, 1997, to March 19, 2013, aged 18-75 years, they had available information about sex, they were not infected perinatally or after the receipt of clotting factor concentrates, and were naive to combination antiretroviral therapy at cohort entry. Migrants' origins were grouped into seven regions: western Europe and similar countries (Australia, Canada, New Zealand, and the USA); eastern Europe; North Africa and the Middle East; sub-Saharan Africa; Latin America; the Caribbean; and Asia and the rest of Oceania (excluding Australia and New Zealand). Crude and adjusted mortality rate ratios were calculated by use of Poisson regression stratified by sex, comparing each group with the native population. Multiple imputation with chained equations was used to account for missing values. Findings: Between Oct 25, 1979, and March 19, 2013, we recruited 279 659 individuals to the COHERE collaboration in EuroCoord. Of these 123 344 men and 45 877 women met the inclusion criteria. Our data suggested effect modification by transmission route (pinteraction=0·12 for men; pinteraction=0·002 for women). No significant difference in mortality was identified by geographical origin in men who have sex with men. In heterosexual populations, most migrant men had mortality lower than or equal to that of native men, whereas no group of migrant women had mortality lower than that in native women. High mortality was identified in heterosexual men from Latin America (rate ratio [RR] 1·46, 95% CI 1·00-2·12, p=0·049) and heterosexual women from the Caribbean (1·48, 1·29-1·70, p

Original languageEnglish
Pages (from-to)e540-e549
JournalThe Lancet HIV
Volume2
Issue number12
DOIs
Publication statusPublished - Dec 1 2015

ASJC Scopus subject areas

  • Infectious Diseases
  • Epidemiology
  • Immunology
  • Virology

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