Increased risk of virological failure to the first antiretroviral regimen in HIV-infected migrants compared to natives: data from the ICONA cohort
Articolo
Data di Pubblicazione:
2016
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 virological failure (VF), and determinants of failure were evaluated. Variables associated with initiating antiretroviral therapy (ART) were analyzed. Primary endpoint was time to failure after at least 6 months of ART and (?) defined as: (a) VF, as first of two consecutive viral loads (VL) >200 copies/ml, (b) TD (treatment discontinuation) for any reason, (c) TF (treatment failure) as confirmed VL>200 cp/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 (OR 0.80, 95% IC 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 (IRR 1.90, 95%CI 1.25-2.91, p=0.003) and TF (IRR 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-PI based-regimen vs NNRTIs. Despite the use of more potent and safer drugs in the last ten 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.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
HIV; ICONA; antiretroviral therapy; migrants; virological failure
Elenco autori:
Saracino, A; Lorenzini, P; Lo Caputo, S; Girardi, E; Castelli, F; Bonfanti, P; Rusconi, S; Caramello, P; Abrescia, N; Mussini, C; Monno, L; d'Armionio Monforte, A; Moroni, M; Andreoni, M; Angarano, G; Antinori, A; Cauda, R; Di Perri, G; Galli, M; Iardino, R; Ippolito, G; Lazzarin, A; F Perno, C; von Schloesser, F; Viale, P; Castagna, A; Ceccherini-Silberstein, F; Cozzi-Lepri, A; Puoti, M; Ammassari, A; Balotta, C; Bonora, S; Borderi, M; R Capobianchi, M; Cingolani, A; Cinque, P; De Luca, A; Di Biagio, A; Gianotti, N; Gori, A; Guaraldi, G; Lapadula, G; Lichtner, M; Madeddu, G; Maggiolo, F; Marchetti, G; Marcotullio, S; QUIROS ROLDAN, Maria Eugenia; Cicconi, P; Fanti, I; Galli, L; Shanyinda, M; Tavelli, A; Giacometti, A; Costantini, A; Mazzoccato, S; Santoro, C; Suardi, C; Vanino, E; Verucchi, G; Minardi, C; Quirino, T; Abeli, C; E Manconi, P; Piano, P; Vecchiet, J; Falasca, K; Sighinolfi, L; Segala, D; Mazzotta, F; Cassola, G; Viscoli, C; Alessandrini, A; Piscopo, R; Mazzarello, G; Mastroianni, C; Belvisi, V; Caramma, I; Chiodera, A; P Castelli, A; Rizzardini, G; L Ridolfo, A; Piolini, R; Salpietro, S; Carenzi, L; C Moioli, M; Tincati, C; Puzzolante, C; Chirianni, A; Borgia, G; G Guida, M; Gargiulo, M; Gentile, I; Orlando, R; Baldelli, F; Francisci, D; Parruti, G; Ursini, T; Magnani, G; A Ursitti, M; Vullo, V; D'Avino, A; Gallo, L; Nicastri, E; Acinapura, R; Capozzi, M; Libertone, R; Tebano, G; Zaccarelli, M; Viviani, F; Sasset, L; S Mura, M; Rossetti, B; Di Perri, G; C Orofino, G; Sciandra, M; Bassetti, M; Londero, A; Pellizzer, G; Manfrin, V
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