Do HIV-Infected Immigrants Initiating HAART have Poorer Treatment-Related Outcomes than Autochthonous Patients in Spain? Results of the GESIDA 5808 Study.

OBJECTIVE: currently, 12% of the Spanish population is foreign-born, and a third of newly diagnosed HIV-infected patients are immigrants. We determined whether being an immigrant was associated with a poorer response to antiretroviral treatment. METHODS: historical multicenter cohort study of naïve patients starting HAART. The primary endpoint was time to treatment failure (TTF) defined as virological failure (VF), death, opportunistic disease, treatment discontinuation (D/C), or missing patient. Secondary endpoints were TTF expressed as observed data (TFO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/C not due to VF). A multivariate analysis was performed to control for confounders. RESULTS: a total of 1090 treatment-naïve HIV-infected patients (387 immigrants and 703 autochthonous) from 33 hospitals were included. Most immigrants were from Sub-Saharan Africa (28.3%) or South-Central America/Caribbean (31%). Immigrants were significantly younger (34 y vs. 39 y), more frequently female (37.5% vs. 24.6%), with less HCV coinfection than autochthonous patients (7% vs. 31.3%). There were no differences in baseline viral load (4.95 Log(10) vs. 4.98 Log(10)), CD4 lymphocyte count (193.5/µL vs. 201.5/µL), late initiation of HAART (56.4% vs. 56.0%), or antiretrovirals used. Cox-regression analysis (HR; 95%CI) did not show differences in TTF (0.89; 0.66-1.20), TFO (0.95; 0.66-1.36), or TVF (1.00; 0.57-1.78) between immigrants and autochthonous patients. Losses to follow-up were more frequent among immigrants (17.8% vs. 12.1; p=0.009). Sub-Saharan African patients and immigrant females had a significantly shorter TTF. CONCLUSIONS: the response to HAART among immigrant patients was similar to that of autochthonous patients, although they had a higher rate of losses to follow-up. Sub-Saharan Africans and immigrant females may need particular measures to avoid barriers hindering antiviral efficacy.

[HIV infection in immigrants: clinical and epidemiological differences as compared to the native population in a Health Area in Madrid (2002-2004)]. / Infección por el VIH en inmigrantes: diferencias clínico-epidemiológicas con la población autóctona en un área de salud de la Comunidad de Madrid (2001-2004).

OBJECTIVE: To describe the incidence and characteristics of immigrant patients attended in a dedicated HIV Unit in Madrid (Spain). METHODS: Cross-sectional study including all patients whose first visit to our HIV Unit took place between January 2001 and December 2004. RESULTS: Among a total of 516 new patients seen during the study period, 101 (19.6%) were immigrants (59% from Latin America, 27% from sub-Saharan Africa). Considering only patients who had not received previous clinical care in other centers (n = 298), 25.5% were immigrants. As compared to Spanish patients, there was a higher proportion of women among the immigrant population (40% vs. 26%: P = 0.008), age was lower (35 vs. 38 years; P = 0.003), and educational level was higher (39% vs. 13% secondary or higher education; P < 0.0001), with no statistical differences regarding employment (37% vs. 27% were unemployed; P = 0.07). Sexual transmission was more frequent among immigrants (85% vs. 37%; P < 0.0001), but the main sexual route of infection in both groups was heterosexual contact (71% and 66%). There were no differences in the baseline clinical, immunological, or virological status. CONCLUSION: A large number of new patients attended for the first time in a dedicated HIV Clinic in Madrid were immigrants. Although these patients showed some differences in demographic characteristics and the mechanism of HIV transmission, no significant differences were found in their clinical or immunological characteristics as compared to Spanish patients.