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

PLoS One. 2018 Oct 31;13(10):e0205385. doi: 10.1371/journal.pone.0205385. eCollection 2018.

Abstract

Background: The influence of geographic origin on the risk of severe illness and death on cART has not been explored in European countries.

Method: We 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.

Results: Among 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.

Conclusion: Heterosexual 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology
  • Acquired Immunodeficiency Syndrome / etiology
  • Acquired Immunodeficiency Syndrome / mortality
  • Acquired Immunodeficiency Syndrome / pathology*
  • Adult
  • Africa South of the Sahara / epidemiology
  • Anti-Retroviral Agents / therapeutic use*
  • Databases, Factual
  • Drug Therapy, Combination
  • Female
  • France / epidemiology
  • HIV Infections / complications
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • Heterosexuality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Morbidity
  • Poisson Distribution
  • Risk
  • Severity of Illness Index
  • West Indies / epidemiology

Substances

  • Anti-Retroviral Agents

Grants and funding

The FHDH is supported by the ANRS ("France REcherche Nord&Sud Sida-hiv Hépatites"), INSERM, and the French Ministry of Health. Laure-Amelie de Monteynard was supported by a doctoral contract from Sorbonne Universités UPMC Paris Univ 06.