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HIV Med. 2013 May;14(5):273-83. doi: 10.1111/hiv.12001. Epub 2012 Nov 21.

Inequalities in HIV disease management and progression in migrants from Latin America and sub-Saharan Africa living in Spain.

Collaborators (215)

Berenguer J, del Amo J, García F, Gutiérrez F, Labarga P, Moreno S, Muñoz MÁ, Sobrino P, Alejos B, Hernando V, Alvarez D, Monge S, Jarrin I, Muñoz MÁ, García- Merino I, Gómez C, Gallego J, García A, Sogorb JP, Merino de Lucas E, Bañuls SR, Martínez VB, Oncina LG, Pastor CG, Tamarit IP, Toledo PA, Gómez Sirvent JL, Rodríguez Fortúnez P, Remedios M, Valls A, del Mar Alonso Socas M, María A, Lirola L, Hernández MI, Díaz-Flores F, Soriano V, Labarga P, Barreiro P, Rivas P, Blanco F, Carbonero LM, Vispo E, Solera C, Asensi V, Valle E, Antonio J, Miró JM, López-Dieguez M, Manzardo C, Zamora L, Pérez I, García MT, Ligero C, Blanco JL, García-Alcaide F, Martínez E, Mallolas J, Gatell JM, Rubio R, Pulido F, Fiorante S, Llenas J, Rodríguez V, Matarranz M, Iribarren JA, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Galparsoro HA, Gutiérrez F, Masiá M, Ramos JM, Padilla S, Navarro A, Montolio F, Peral Y, García CR, Clotet B, Tural C, Ruiz L, Miranda C, Muga R, Tor J, Sanvisens A, Berenguer J, López Bernaldo de Quirós JC, Miralles P, Ochaíta JC, Conde MS, Cuellar IG, Schacke MR, Ortega BP, Vidaurreta PG, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, López-Dupla M, Olona M, Aguilar A, Sirvent JJ, Soriano A, Qaneta RA, Aldeguer JL, Juliá MB, Rodrigo JL, Salavert M, Montero M, Calabuig E, Cuéllar S, González García J, de la Serna IB, Sánchez de Rivera JM, López JR, Ramírez ML, Pareja JF, Arribas B, Castro JM, Vargas FJ, Valero IP, Estebanez M, Arnalich Fernández RM, Sanz S, Rodríguez J, Aparicio AS, Cepeda CS, Oteo JA, Blanco JR, Ibarra V, Metola L, Sanz M, Pérez- Martínez L, Pinilla J, Dalmau D, Manzanera AJ, Llobell MC, Puig DI, Ibáñez L, Montañez QJ, Valls MX, Martinez-Lacasa J, Velli P, Font R, Boneta JS, Uriz J, Castiello J, Reparaz J, Arraiza MJ, Irigoyen C, Mozas D, Segura F, Amengual MJ, Penelo E, Navarro G, Sala M, Cervantes M, Pineda V, Moreno S, Casado JL, Dronda F, Moreno A, Elías MJ, López D, Gutiérrez C, Hernández B, Pumares M, Martí P, Sofía R, Sánchez AC, Morell EB, Pérez ÁM, García FG, Quero JH, Monje AP, Medina LM, Ruiz JP, Del Romero Guerrero J, Martín CR, López TP, Montiel JC, González C, Vera M, Antela A, Prieto A, Losada E, Riera M, Murillas J, Peñaranda M, Leyes M, Ribas MA, Campins A, Villalonga C, Vidal C, Pineda JA, Sánchez ER, Lozano de León F, Macías J, del Valle J, Gómez-Mateos J, Mata R, González JS, Solero MM, Ramos IV, Muñoz RP, Viciana P, Leal M, López-Cortés LF, Trastoy M, Sanz JS.

Author information

1
AIDS Research Network, National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain. smonge@isciii.es

Erratum in

  • HIV Med. 2014 Jan;15(1):64.

Abstract

OBJECTIVES:

The objective of the study was to analyse key HIV-related outcomes in migrants originating from Latin America and the Spanish-speaking Caribbean (LAC) or sub-Saharan Africa (SSA) living in Spain compared with native Spaniards (NSP).

METHODS:

The Cohort of the Spanish AIDS Research Network (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 Fine and Gray 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 [hazard ratio (HR) [corrected] 0.8 (95% CI 0.7-1.0) and HR [corrected] 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 [HR 2.0 (95% CI 1.1-3.7) and HR [corrected] 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.

PMID:
23171059
DOI:
10.1111/hiv.12001
[Indexed for MEDLINE]
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