Influence of geographic origin, sex, and HIV transmission group on the outcome of first-line combined antiretroviral therapy in France

Monteynard, Laure-Amélie de; Matheron, Sophie; Gilquin, Jacques; Pavie, Juliette; Truchis, Pierre de; Grabar, Sophie; Launay, Odile; Meynard, Jean-Luc; Khuong-Josses, Marie-Aude; Rey, David; Simon, Anne; Mahamat, Aba; Dray‐Spira, Rosemary; Costagliola, Dominique; Abgrall, Sophie

doi:10.1097/qad.0000000000001193

Cited by 8 publications

(13 citation statements)

References 41 publications

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“…In addition to the factors mentioned above, older age, male sex, lower nadir CD4 T‐cell counts, lower CD4/CD8 ratios, and a lower naïve/memory CD4 + T‐cell ratio have been associated with a blunted immunological response to ART treatment. Ethnic origin is also associated with immune recovery . Furthermore, host genetic factors, metabolic characteristics, and specific ART regimens may play a role in incomplete immune recovery.…”

Section: Potential Mechanisms Of Incomplete Immune Reconstitutionmentioning

confidence: 99%

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Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

Yang

Zhang

et al. 2020

Journal of Leukocyte Biology

191

214

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The morbidity and mortality of HIV type‐1 (HIV‐1)‐related diseases were dramatically diminished by the grounds of the introduction of potent antiretroviral therapy, which induces persistent suppression of HIV‐1 replication and gradual recovery of CD4+ T‐cell counts. However, ∼10–40% of HIV‐1‐infected individuals fail to achieve normalization of CD4+ T‐cell counts despite persistent virological suppression. These patients are referred to as “inadequate immunological responders,” “immunodiscordant responders,” or “immunological non‐responders (INRs)” who show severe immunological dysfunction. Indeed, INRs are at an increased risk of clinical progression to AIDS and non‐AIDS events and present higher rates of mortality than HIV‐1‐infected individuals with adequate immune reconstitution. To date, the underlying mechanism of incomplete immune reconstitution in HIV‐1‐infected patients has not been fully elucidated. In light of this limitation, it is of substantial practical significance to deeply understand the mechanism of immune reconstitution and design effective individualized treatment strategies. Therefore, in this review, we aim to highlight the mechanism and risk factors of incomplete immune reconstitution and strategies to intervene.

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Section: Potential Mechanisms Of Incomplete Immune Reconstitutionmentioning

confidence: 99%

“…Ethnic origin is also associated with immune recovery. [171][172][173][174] Furthermore, host genetic factors, metabolic characteristics, and specific ART regimens may play a role in incomplete immune recovery. Luo…”

Section: Other Factors Associated With Immune Reconstitutionmentioning

confidence: 99%

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

Yang

Zhang

et al. 2020

Journal of Leukocyte Biology

191

214

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“…After adjustment, migrants from SSA were half as likely to have virological suppression on cART as other individuals. Previous studies have found lower virological response rates in migrants from SSA than in nonmigrants, mainly in men [3,6,7]. Similarly, socioeconomic factors and lifestyle factors, which could explain some differences in adherence between migrants, especially migrants from SSA, and natives or people from Western Europe [17][18][19], were not recorded.…”

Section: Discussionmentioning

confidence: 96%

Does region of origin influence the timing and outcome of first‐line antiretroviral therapy in France?

Gatey

Brun²,

Hamet³

et al. 2018

HIV Medicine

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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.

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“…In high-income countries, HIV-infected adults with controlled infection and high CD4 cell counts currently live longer than ever before [ 1 ], and the main causes of morbidity and mortality have switched from AIDS-defining to non-AIDS-defining disorders [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. In western European countries, despite experiencing more AIDS-defining events [ 10 , 11 ], migrants from sub-Saharan Africa (SSA) have lower mortality than non-migrants, mainly owing to lower non-AIDS mortality [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…In western European countries, despite experiencing more AIDS-defining events [ 10 , 11 ], migrants from sub-Saharan Africa (SSA) have lower mortality than non-migrants, mainly owing to lower non-AIDS mortality [ 12 ]. In France, heterosexual migrant men originating from SSA and non-French West Indies (NFW), and non-migrant men, have a higher risk of new AIDS-defining events, serious non-AIDS events or death after cART initiation than non-migrant men who have sex with men (MSM), while this is not the case of women [ 9 ]. This latter study compared heterosexual individuals to MSM, two groups with different socioeconomic and lifestyle factors, and specific causes of morbidity were not assessed.…”

Section: Introductionmentioning

confidence: 99%

Influence of geographic origin on AIDS and serious non-AIDS morbidity/mortality during cART among heterosexual HIV-infected men and women in France

Monteynard¹,

Matheron²,

Grabar³

et al. 2018

PLoS ONE

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BackgroundThe influence of geographic origin on the risk of severe illness and death on cART has not been explored in European countries.MethodWe studied antiretroviral-naïve heterosexual HIV-1-infected individuals enrolled in the FHDH-ANRS CO4 cohort in France who started cART between 2006 and 2011. Individuals originating from France (French natives), sub-Saharan Africa (SSA) and non-French West-Indies (NFW) were studied until 2012. Crude and adjusted rate ratios (aRR) of severe morbid events/deaths (AIDS-related and non-AIDS-related) were calculated using Poisson regression models stratified by sex, comparing each group of migrants to French natives.ResultsAmong 2334 eligible men, 1379 (59.1%) originated from France, 838 (35.9%) from SSA and 117 (5.0%) from NFW. SSA male migrants had a higher aRR for non-AIDS infections, particularly bacterial infections (aRR 1.56 (95% CI 1.07–2.29), p = 0.0477), than French natives. Among 2596 eligible women, 1347 (51.9%) originated from France, 1131 (43.6%) from SSA, and 118 (4.5%) from NFW. SSA and NFW female migrants had a higher aRR for non-AIDS infections, particularly non-bacterial infections (respectively, 2.04 (1.18–3.53) and 7.87 (2.54–24.4), p = 0.0010), than French natives. We observed no other significant differences related to geographic origin as concerns the aRRs for AIDS-related infections or malignancies, or for other non-AIDS events/deaths such as cardiovascular disease, neurological/psychiatric disorders, non-AIDS malignancies and iatrogenic disorders, in either gender.ConclusionHeterosexual migrants from SSA or NFW living in France have a higher risk of non-AIDS-defining infections than their French native counterparts. Special efforts are needed to prevent infectious diseases among HIV-infected migrants.

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Influence of geographic origin, sex, and HIV transmission group on the outcome of first-line combined antiretroviral therapy in France

Abstract: Compared with FRA MSM, all migrants had a lower likelihood of CD4 cell recovery, and nonhomosexual men had a higher likelihood of negative virological and clinical outcomes.

Cited by 8 publications

References 41 publications

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

Does region of origin influence the timing and outcome of first‐line antiretroviral therapy in France?

Influence of geographic origin on AIDS and serious non-AIDS morbidity/mortality during cART among heterosexual HIV-infected men and women in France

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