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Inequalities in HIV disease management and progression in migrants from L atin A merica and sub‐ S aharan A frica living in S pain
Author(s) -
Monge S,
Alejos B,
Dronda F,
Del Romero J,
Iribarren JA,
Pulido F,
Rubio R,
Miró JM,
Gutierrez F,
Del Amo J
Publication year - 2013
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12001
Subject(s) - medicine , confidence interval , odds ratio , demography , logistic regression , antiretroviral therapy , cohort , latin americans , human immunodeficiency virus (hiv) , multivariate analysis , viral load , immunology , linguistics , philosophy , sociology
Objectives The objective of the study was to analyse key HIV ‐related outcomes in migrants originating from L atin A merica and the S panish‐speaking C aribbean ( LAC ) or sub‐ S aharan A frica ( SSA ) living in S pain compared with native S paniards ( NSP ). Methods The C ohort of the S panish AIDS R esearch N etwork ( CoRIS ) is an open, prospective, multicentre cohort of antiretroviral‐naïve patients representing 13 of the 17 Spanish regions. The study period was 2004–2010. Multivariate logistic or F ine and G ray regression models were fitted as appropriate to estimate the adjusted effect of region of origin on the different outcomes. Results Of the 6811 subjects in CoRIS , 6278 were NSP (74.2%), LAC (19.4%) or SSA (6.4%). For these patients, the follow‐up time was 15870 person‐years. Compared with NSP , SSA and LAC under 35 years of age had a higher risk of delayed diagnosis [odds ratio ( OR ) 2.0 (95% confidence interval ( CI ) 1.5–2.8) and OR 1.7 (95% CI 1.4–2.1), respectively], as did LAC aged 35–50 years [ OR 1.3 (95% CI 1.0–1.6)]. There were no major differences in time to antiretroviral therapy ( ART ) requirement or initiation. SSA exhibited a poorer immunological and virological response [ OR 0.8 (95% CI 0.7–1.0) and OR 0.7 (95% CI 0.6–0.9), respectively], while no difference was found for LAC . SSA and LAC showed an increased risk of AIDS for ages between 35 and 50 years [ OR 2.0 (95% CI 1.1–3.7) and OR 1.6 (95% CI 1.1–2.4), respectively], which was attributable to a higher incidence of tuberculosis. However, no statistically significant differences were observed in mortality. Conclusions Migrants experience a disproportionate diagnostic delay, but no meaningful inequalities were identified regarding initiation of treatment after diagnosis. A poorer virological and immunological response was observed in SSA . Migrants had an increased risk of AIDS , which was mainly attributable to tuberculosis.