LLV was infrequent in our series and the follow-up did not evidence a higher rate of virological failure than in fully suppressed patients. LLV seems to be a transient phenomenon that might be driven by residual ongoing viral replication and/or viral release and/or accuracy of viral load assay at lower values.
Objectives
The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment.
Methods
Antiretroviral therapy‐naïve HIV‐1‐infected adults with at least two follow‐up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)‐containing cART among individuals initiating cART, and with 1‐year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub‐Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses.
Results
Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36–0.82; and aOR 0.52; 95% CI 0.28–0.98, respectively]. PI‐containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL.
Conclusions
Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
Objective:
To assess updated mortality and causes of death in people living with HIV (PLWH) in France.
Design and Methods:
We analyzed all deaths in PLWH followed up between 01/01/2020 and 31/12/2021 in 11 hospitals in the Paris region. We described the characteristics and causes of death among deceased PLWH, and evaluated the incidence of mortality and associated risk factors using a multivariate logistic regression.
Results:
Of the 12942 patients followed in 2020-2021, 202 deaths occurred. Mean annual incidence of death (95% confidence interval [CI]) was 7.8 per 1 000 PLWH (6.3–9.5). Forty-seven patients (23%) died from non-AIDS non-viral hepatitis (NANH)-related malignancies, 38 (19%) from non-AIDS infections (including 21 cases of COVID-19), 20 (10%) from AIDS, 19 (9%) from cardiovascular diseases (CVD), 17 (8.4%) from other causes, six (3%) from liver diseases and five (2.5%) from suicides/violent deaths. The cause of death was unknown in 50 (24.7%) patients. Risks factors for death were age (adjusted Odds Ratio (aOR) 1.93; 1.66–2.25 by additional decade), AIDS history (2.23; 1.61–3.09), low CD4 (1.95; 1.36–2.78 for 200–500/μL and 5.76; 3.65–9.08 for ≤ 200/μL versus > 500/μL), and viral load > 50 copies/mL (2.03; 1.33–3.08), both at last visit.
Conclusions:
NANH malignancies remained in 2020–2021 the first cause of death. COVID-19 accounted for more than half of the mortality related to non-AIDS infections over the period. Aging, AIDS history, and a poorer viro-immunological control were associated with death.
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