During their first year of antiretroviral therapy (ART), migrants in Europe, the United States, and Canada had a 20% higher rate of new AIDS-defining events than nonmigrants, according to results of a 48,854-person analysis. But migrants did not have a higher death rate in the first year of ART.
In low-income countries rates of AIDS-defining events and death are higher during the first years of ART than in later years. Because little is known about early AIDS and death rates among people from those countries who migrant to high-income countries, the Antiretroviral Therapy Cohort Collaboration (ART-CC) conducted this study.
The analysis involved 48,854 HIV-positive people starting ART in Europe, the United States, and Canada. One quarter of those people (25.6%) were foreign-born migrants, including 16.1% from sub-Saharan Africa, 5.6% from Latin America, 2.3% from North Africa or the Middle East, and 1.6% from Asia.
During the first year of ART, overall incidence of new AIDS-defining diagnoses was 60.8 per 1000 person-years, meaning about 61 of every 1000 people had a new AIDS diagnosis in a year. AIDS incidence rates were 69.9 per 1000 person-years for migrants and 57.7 per 1000 person-years for nonmigrants.
Statistical analysis adjusted for gender, age, CD4 count, viral load, antiretroviral regimen, prior AIDS, probable route of HIV infection, and year starting ART determined that migrants had about a 20% higher risk of AIDS in the first year of ART (adjusted hazard ratio [aHR] 1.21, 95% confidence interval [CI] 1.09 to 1.34).
Tuberculosis incidence was substantially higher in migrants than nonmigrants (14.3 versus 6.3 per 1000 person-years). Those rates meant migrants had almost a doubled risk of TB in the first year of ART (aHR 1.94, 95% CI 1.53 to 2.46).
Migrants had a slightly lower death rate in the first year of ART than nonmigrants, though that difference was not statistically significant in an analysis adjusted for death risk factors (aHR 0.91, 95% CI 0.76 to 1.09).
The researchers believe the high TB rate in the first year of ART among migrants highlights “the importance of screening for tuberculosis prior to ART initiation in this population.”
Source: The Antiretroviral Therapy Cohort Collaboration (ART-CC). Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis. AIDS. 2013; 27: 1321-1329.
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Source: IAS