Clinical Differences and Viral Diversity between Newly HIV Type 1-Diagnosed African and Non-African Patients in Spain (2005–2007)

Abstract

The diagnosis of HIV-1 is increasing in African-born persons residing in Europe. They present a high prevalence of HIV-1 non-B variant infections and of parasitic infections, both of which are infrequent in Western countries. Immigration favors their presence in nonendemic countries. In this study, all newly HIV-diagnosed individuals at an HIV/AIDS and Tropical Medicine reference center in Madrid from 2005 through 2007 were retrospectively studied. HIV-1 subtyping was performed in gag, pol, and gp41 coding regions by phylogenetic analyses. The presence of other pathogens was also evaluated. Furthermore, all HIV-1-infected Africans were screened for parasitic infections. Newly diagnosed HIV-1 subjects included 90 sub-Saharan Africans and 188 non-Africans (116 Spaniards, 13 other Europeans, and 59 Latin Americans). Significantly higher numbers of HIV-1-infected Africans than non-Africans were females, acquired HIV-1 by heterosexual contact, and presented a more advanced clinical CDC stage and criteria for starting antiretroviral therapy in the first clinical visit. They predominantly carried non-B subtype infections, mainly intersubtype recombinants. Half of HIV-1-infected Africans had parasitic infections. CD4(+) T cell counts were lower among Africans than Europeans at the time of HIV-1 diagnosis. At 12 months of follow-up after starting antiretroviral treatment, a significantly lower proportion of Africans than non-Africans achieved undetectable viremia due to their higher loss to follow-up. However, CD4(+) T cell recovery and virological failure rates were similar. Therefore, the profile of African HIV-1-infected immigrants varies widely with respect to Spanish HIV-infected individuals. More advanced immunodeficiency and the coexistence of parasitic diseases and infections with a large diversity of HIV-1 non-B and recombinant variants are expected.

Predictors of Delayed Diagnosis and Evolution in Sub-Saharan Immigrants with HIV Infection in a Hospital in Madrid (2004–2013)

“…This was very different from the proportions found in other Spanish cohorts in which Latin American immigrants predominated and was more similar to other European series [4,5]. As a result, non-B HIV subtypes were much more frequent in our study than in other studies [8,16,17].…”

“…Immigrants in the majority of studies (especially Africans) are diagnosed and begin treatment much later than the native populations [4][5][6][7][8]. This delayed diagnosis is also associated with the male sex, heterosexual transmission, intravenous drug use, and an older age at diagnosis [5][6][7][8][9].…”

“…This delayed diagnosis is also associated with the male sex, heterosexual transmission, intravenous drug use, and an older age at diagnosis [5][6][7][8][9]. Although the evolution of HIV infection does not seem to vary by origin, women and subSaharan Africans have been described as vulnerable populations [4,10].…”

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study*

“…In our study, patients from southeastern Asia enrolled with the most advanced stage of HIV infection. While there is evidence of an increased risk of sub-Saharan Africans presenting late [20,21], there is less awareness of the risk of seropositivity in southeastern Asia migrants [22]. TB as an AIDS-defining infection was found to be most prevalent in sub-Saharan Africa, reflecting the high prevalence of HIV/TB coinfections in African countries, where more than 30% of all new TB cases in adults are estimated to be associated with HIV infection [23].…”

Most HIV Type 1 Non-B Infections in the Spanish Cohort of Antiretroviral Treatment-Naïve HIV-Infected Patients (CoRIS) Are Due to Recombinant Viruses

“…The coexistence of multiple variants in the same region favors recombination between them after coinfection and/or superinfection events. In Spain, an increase in the frequency of HIV-1 non-B subtypes has been found among native Spaniards and immigrants newly diagnosed with HIV-1 in recent years (23), and the presence of different recombinants has been published (11,14,16,21,23,24,34,52,53).…”