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Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis

Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis

Authors :
Cathy A. Jenkins
Deidra D. Parrish
Sophie Abgrall
Angels Masabeu
Geneviève Chêne
Heidi M. Crane
Julia del Amo
Clara Lehmann
Inma Jarrín
Jonathan A C Sterne
Angela Cescon
Frank de Wolf
Tracy R. Glass
Suzanne M Ingle
Margaret T May
John Gill
Bryan Shepherd Shepherd
Timothy R. Sterling
Pavel Khaykin
Other departments
Amsterdam institute for Infection and Immunity
Amsterdam Public Health
Global Health
Source :
AIDS (London, England), 27(8), 1321-1329. Lippincott Williams and Wilkins
Publication Year :
2013

Abstract

OBJECTIVE: In lower-income countries rates of AIDS-defining events (ADEs) and death are high during the first year of combination antiretroviral therapy (ART). We investigated differences between foreign-born (migrant) and native-born (nonmigrant) patients initiating ART in Europe the US and Canada and examined rates of the most common ADEs and mortality during the first year of ART. DESIGN: Observational cohort study. METHODS: We studied HIV-positive adults participating in one of 12 cohorts in the Antiretroviral Therapy Cohort Collaboration (ART-CC). RESULTS: Of 48 854 patients 25.6% were migrants: 16.1% from sub-Saharan Africa 5.6% Latin America 2.3% North Africa/Middle East and 1.6% Asia. Incidence of ADEs during the first year of ART was 60.8 per 1000 person-years: 69.9 for migrants and 57.7 for nonmigrants [crude hazard ratio (HR) 1.18; 95% confidence interval (CI) 1.08-1.29] adjusted HR (for sex age CD4 HIV-1 RNA ART regimen prior ADE probable route of infection and year of initiation and stratified by cohort) 1.21 (95% CI 1.09-1.34). Rates of tuberculosis were substantially higher in migrants than nonmigrants (14.3 vs. 6.3; adjusted HR 1.94; 95% CI 1.53-2.46). In contrast mortality was higher among nonmigrants than migrants (crude HR 0.71; 95% CI 0.61-0.84) although excess mortality was partially explained by patient characteristics at start of ART (adjusted HR 0.91; 95% CI 0.76-1.09). CONCLUSIONS: During the first year of ART HIV-positive migrants had higher rates of ADEs than nonmigrants. Tuberculosis was the most common ADE among migrants highlighting the importance of screening for tuberculosis prior to ART initiation in this population.

Details

Language :
English
ISSN :
02699370
Database :
OpenAIRE
Journal :
AIDS (London, England), 27(8), 1321-1329. Lippincott Williams and Wilkins
Accession number :
edsair.doi.dedup.....aa912d44bb2354b5152463f5e306f334