Birth Country Influences the Choice of Antiretroviral Therapy in HIV-Infected Individuals: Experience From a French HIV Centre

Palich, Romain; Agher, Rachid; Wetshikoy, Dimoke J; Seang, Sophie; Soulié, Cathia; Tubiana, Roland; Valantin, Marc‐Antoine; Schneider, Luminita; Pourcher, Valérie; Marcelin, Anne‐Geneviève; Assoumou, Lambert; Katlama, Christine

doi:10.1097/qai.0000000000003114

Cited by 3 publications

(4 citation statements)

References 45 publications

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“…We also performed a sensitivity analysis restricting it to men, to eliminate the potential confounding effect of gender and pregnancy, and this analysis strengthened the result. These findings come as a confirmation to what was found in a previous smaller study by Palich et al [13].…”

Section: Discussionsupporting

confidence: 93%

“…Some authors have highlighted inequalities in treatment based on race, driven by implicit bias among physicians [9][10][11][12]. Recent results from a French monocentric study showed that PWH born abroad may not receive similar first-line regimens as PWH born in France [13]. It should be mentioned that in France, health insurance is free of charge, including for undocumented individuals.…”

Section: Introductionmentioning

confidence: 99%

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Country of birth is associated with antiretroviral therapy choice in treatment-naive persons living with HIV in France

Palich

Hentzien

Hocqueloux

et al. 2023

Aids

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Objectives: We aimed to describe factors associated with the choice of first antiretroviral therapy (ART) in persons with HIV (PWH) in France, included the country of birth, as well as the time to undetectable viral load and treatment discontinuation. Design: Observational study conducted from the national Dat’AIDS prospectively collected database. Methods: We included all adults who started their first ART between 01 January 2014 and 31 December 2020, with a pretherapeutic plasma viral load (pVL) at least 400 copies/ml. Univariable and multivariable logistic regressions were used to analyze PWH characteristics driving to an integrase strand transfer inhibitors (INSTI)-based first prescribed regimen. We also analyzed time to first line discontinuation, and to a first undetectable pVL, using Kaplan–Meier model. Results: We analyzed data from 9094 PWH: 45% MSM, 27% women and 27% heterosexual men; 48% born abroad; 4.7 and 2.8% with concomitant hepatitis B and tuberculosis, respectively. INSTIs were prescribed as first-line therapy in 50% of PWH, which increased over time. Native French PWH were more likely to receive an INSTI-based regimen than PWH born abroad [adjusted prevalence ratio 1.47, 95% confidence interval (CI) 1.33–1.60], as were high pVL at diagnosis, hepatitis B or concomitant tuberculosis. Time before discontinuation of the first ART and reaching a first undetectable pVL was not different according to the place of birth. Conclusion: Despite unrestricted access to INSTIs in France, independently from HIV disease parameters, PWH born abroad received INSTIs less frequently as a first regimen than those born in France. Qualitative data are needed to better understand physicians’ prescribing practices.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Country of birth is associated with antiretroviral therapy choice in treatment-naive persons living with HIV in France

Palich

Hentzien

Hocqueloux

et al. 2023

Aids

Self Cite

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“…prescription of boosted-protease inhibitor-or integrase strand transfer inhibitor-containing ART). Indeed, the distribution of these classes suggested important differences in maintenance ART prescriptions by place of birth, as highlighted in previous studies among treatment-naive PWH [1][2][3].…”

Section: Discussionmentioning

confidence: 81%

“…Recent studies have reported disparities in antiretroviral therapy (ART) prescribing in the United States [1] and France [2,3] as a first line based on race, ethnicity and/or country of birth. Non-White and foreign-born people with HIV (PWH) were less likely to receive integrase stand transfer inhibitor (INSTI)-containing regimens, or to receive them in the earliest calendar periods, than White and native people with HIV.…”

Section: Introductionmentioning

confidence: 99%

Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France

Palich

Hentzien

Hocqueloux

et al. 2023

Aids

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Objectives: We aimed to examine the association of the country of birth and the other patients’ characteristics with the prescription of two-drug regimens (2DRs) in virally suppressed PLWH in France. Design: Observational study conducted from the national Dat’AIDS prospectively collected database. Methods: We included all adults who were actively in care on 31st December 2020 in 26 French centers, with an HIV plasma viral load (pVL) <50 copies/mL for at least 6 months while on ART. Patients with chronic hepatitis B were excluded because they are not eligible to 2DRs. Univariate and multivariate logistic regressions were built to analyze relationships between patients’ characteristics and receiving a 2DR. Results: We analyzed data from 28 395 PLWH: 41.7% men who have sex with men, 31.7% women and 26.5% heterosexual men; 35% born abroad. Median age was 53 years (IQR 44–60); ART duration 14 years (8–23); duration of virological suppression 87 months (42–142). 2DRs (mainly dolutegravir/rilpivirine, 53.8%, or dolutegravir/lamivudine, 41.7%) were prescribed in 16.3% of the patients and were less common in the “born abroad” group (18.9% versus 11.5%). The multivariate model showed that individuals born in France were more likely to receive a 2DR (aOR: 1.62 [1.50–1.74]), independently of other characteristics. Older PLWH and those with higher CD4 T-cell counts were also more likely to receive a 2DR. Conclusion: Despite unrestricted access to ART in France, independently from HIV disease parameters, PLWH born abroad were less likely to receive 2DRs as a maintenance regimen than those born in France. Qualitative data are needed to better understand physicians’ prescribing practices.

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Drastic Reduction in Time to Controlled Viral Load in People With Human Immunodeficiency Virus in France, 2009–2019: A Longitudinal Cohort Study

Cuzin,

Morisot,

Allavena

et al. 2023

Clinical Infectious Diseases

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Background Aspirational targets to end AIDS by 2030 include having 95% of people with human immunodeficiency virus (HIV; PWH) diagnosed, 95% treated, and 95% with controlled viral load (VL). Our objective was to describe, using a large French prospective cohort, the median transition times through the cascade of care between 2009 and 2019. Methods We analyzed patients whose first HIV diagnosis was made between 1 January 2009 and 31 December 2019. Using the Kaplan–Meier method, we estimated the time to linkage to care (from HIV diagnosis to first biological assessment), to treatment (date of first antiretroviral therapy [ART] prescription), and to controlled VL (first value <200 copies/mL). Analyses were disaggregated by time periods and patients' characteristics. Censoring date was 31 December 2021. Results Among the 16 864 patients linked to care since 2009, the median [Q1; Q3] time from HIV diagnosis to controlled VL decreased from 254 [127–745] to 73 [48–132] days in 2009–2011 and 2018–2019, respectively. Transition times from linkage to care to first ART decreased from 67 [17; 414] in 2009–2011 to 13 [5; 26] days in 2018–2019, and from ART to controlled VL from 83 [35; 130] in 2009–2011 to 38 [28; 90] days in 2018–2019. Differences were observed depending on patients' characteristics. Conclusions We describe drastic reductions in transition time through the cascade of care, allowing reduction in the transmission period following each new infection. Delayed diagnosis remains the main obstacle to ending AIDS in the next decade.

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Birth Country Influences the Choice of Antiretroviral Therapy in HIV-Infected Individuals: Experience From a French HIV Centre

Abstract: Objectives: To assess whether antiretroviral therapy (ART) prescriptions differ between naive and virally suppressed HIV patients born in France (PBFs) and in Sub-Saharan Africa (PBSSAs).

Cited by 3 publications

References 45 publications

Country of birth is associated with antiretroviral therapy choice in treatment-naive persons living with HIV in France

Country of birth is associated with antiretroviral therapy choice in treatment-naive persons living with HIV in France

Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France

Drastic Reduction in Time to Controlled Viral Load in People With Human Immunodeficiency Virus in France, 2009–2019: A Longitudinal Cohort Study

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