Abstract Body

Cohort studies on outcomes after cART initiation according to geographic origin (GO) show conflicting results. We thus aimed to compare biological and clinical outcomes on cART in HIV-1-infected individuals in France, according to GO, sex and transmission group.

Antiretroviral-naïve HIV-1-infected adults enrolled in the FHDH-ANRS CO4 cohort, originating either from France (FRA) or from sub-Saharan Africa or non-French West Indies (SSA/NFW), and who started cART between 2006 and 2011 were included. Women initiating cART because of pregnancy were excluded. We assessed 2-year Kaplan-Meier (KM) probabilities and adjusted hazard ratios (aHRs) for undetectability (2 consecutive plasma viral loads (pVL) <50 copies/mL) and CD4 cell recovery (2 consecutive CD4 >500/µL), and 5-year cumulative incidences (CI) and adjusted subdistribution-hazard ratios (aSHRs) for clinical outcome (AIDS-event, serious non-AIDS-event (SNAE) or death) using competing risk models taking into account loss to follow-up, according to GO, sex and transmission group. Models were adjusted for demographic, immunovirological data and therapeutics at cART initiation (table), plus time-updated undetectability in immunological analysis or plus time-updated undetectability and CD4 increase >50/µL in clinical analyses.

Among 9746 individuals, 7297 (74.9%) were native from FRA and 2449 (25.1%) were migrants from SSA/NFW, of whom 1552 (21.3%) and 1350 (55.1%) were women respectively. A higher proportion of patients from SSA/NFW (38.1%) than from FRA (27.5%) initiated cART with CD4 <200 cells/µL (p<0.0001). After cART initiation and compared to FRA men who have sex with men (MSM), aHRs for undetectability were lower in men whatever their origin and slightly lower in FRA women; aHRs for CD4 cell recovery were lower in all groups of patients except for FRA non homosexual men; aSHRs of clinical outcomes (359 individuals with a new-AIDS event mainly in the first 6 months of cART, 1366 with NSAE, 49 deaths) were higher in men whatever their origin and borderline significant higher in SSA/NFW women. AIDS status, older age and lower CD4 cell count at cART initiation had the highest impact on the change between the crude and adjusted SHRs of clinical outcomes.

Although migrants initiated cART at lower CD4 count and had the lowest likelihood of CD4 cell recovery compared to FRA MSM, male sex in non homosexuals whatever the geographic origin had a negative impact on undetectability and clinical outcome.