|
Response to antiretroviral therapy in HIV-positive migrants of Sub-Saharan African origin within the Swiss HIV Cohort Study (SHCS)
Presented by Cornelia Staehelin, Switzerland.
C. Staehelin1, O. Keiser2, A. Calmy3, R. Weber4, M. Cavassini5, L. Elzi6, P. Schmid7, E. Bernasconi8, H. Furrer9, Swiss HIV Cohort Study
1University Hospital, Bern, Switzerland, 2University of Bern, Institute of social and Preventive Medicine, Bern, Switzerland, 3University Hospital, Geneva, Switzerland, 4University Hospital, Zürich, Switzerland, 5University Hospital, Lausanne, Switzerland, 6University Hospital, Basel, Switzerland, 7Cantonal Hospital, St. Gallen, Switzerland, 8Regional Hospital, Lugano, Switzerland, 9University of Bern, Bern, Switzerland
Background: The proportion of Sub-Saharan African (SSA) patients within the SHCS increases steadily and reached 18.5% in 2004-2007. Treating HIV-positive migrants can pose considerable difficulties due to socio-cultural and language barriers. Studies from other European countries have demonstrated an inferior outcome on combined antiretroviral therapy (cART) for African patients.
Methods: Intention-to-treat comparison of responses to cART in antiretroviral-naïve patients of SSA and Northwestern European (NWE) origin. Endpoints were time to HIV RNA <50c/ml, virologic failure, CDC C events and death, and increase in CD4-count. Multivariable Cox-models included age, sex, hepatitis C, CD4 and RNA levels and AIDS at baseline.
Results: 16% of the 3707 participants were from SSA. They were younger, predominantly female, infected heterosexually and had lower median CD4 counts (SSA: 189, NWE: 208, p=0.02) and HIV-RNA levels (SSA: 4.7log10, NWE: 4.9log10, p<0.001) at baseline. Median follow-up was 4.0 years in SSA and 5.2 in NWE. Cumulative incidence at 12/24 months: viral suppression 0.79/0.88 (NWE) and 0.79/0.86 (SSA); virologic failure 0.06/0.15 (NWE) and 0.07/0.16 (SSA); C event 0.03/0.05 (NWE) and 0.04/0.05 (SSA); death 0.023/0.044 (NWE) and 0.014/0.018 (SSA). Non-significant trend towards higher viral failure in SSA after 3 years.
| Time to: | Crude HR (95% CI) | Adj. HR (95% CI) | p-value | | Viral suppression | 1.07 (0.97-1.17) | 1.17 (1.04-1.32) | 0.008 | | Viral failure >400c/ml | 1.14 (0.97-1.34) | 1.09 (0.89-1.35) | 0.4 | | C-event | 0.99 (0.7-1.4) | 1.4 (0.9-2.2) | 0.1 | | Death | 0.3 (0.2-0.6) | 0.8 (0.4-1.4) | 0.4 | | | SSA | NWE | | | Median CD4-increase 1 year (IQR) | +160 (70-241) | +155 (70-268) | 0.4 | | Median CD4-increase in 4 years (IQR) | +241 (115-389) | +262 (118-421) | 0.4 |
Conclusions: Current data show little evidence for inferior outcome to cART in SSA migrants, however there is concern over longer-term stability of viral response.
|