2023-05-31 21:10:31
Why is this important?
Compliance with antiretroviral treatment by PLHIV is multifactorial. Although it is difficult to predict, it has been established in France that PLHIV of foreign origin are often less observant. This might be an argument for prescribing alternative treatments to the most recent and tolerated therapeutic regimens, as suggested by a recent French monocentric study.
Given that no limitation of access to treatment exists on the administrative or economic level in France, the socio-economic level of PLHIV should not have an impact on the nature of the treatment received. Also, second-generation INSTIs (dolutegravir and bictegravir), which are well tolerated and have high antiviral potency and a high genetic barrier, should be accessible regardless, especially in those with a high initial viral load, a low CD4+ cell count or who have associated tuberculosis (lower risk of drug interactions). Only precautions are necessary in pregnant women or women of childbearing age (risk of neural tube defects). It appears in this study that other parameters seem to influence the choice of therapeutic strategy by practitioners.
Methodology
This study was conducted using all patients ≥18 years old seen in one of the 26 centers participating in the Dat’AIDS cohort, who had a plasma viral load >400 copies/mL and who were receiving triple therapy for the first time. from the beginning of 2014 (date of availability of dolutegravir in France).
Principle results
In total, data from 9,094 PLHIV (34-37 years old on average) were collected and analyzed. Among the participants, 48% were born abroad (29% in sub-Saharan Africa). Compared to those born in France, they had on average a lower CD4+ count at diagnosis (290 vs 404/mm3), more often had tuberculosis (4.2% vs 0.5%) or associated hepatitis B (8.2 vs 1,5%).
Regarding care, people born abroad had a slightly longer delay between the diagnosis of HIV infection and the first prescription of ART than those born in France, and they had less often received a treatment comprising INSTI than the others (44% once morest 56%).
Being born in France was independently associated with receiving triple therapy including an INSTI (adjusted prevalence ratio 1.73 [1,59-1,87]). INSTIs were also more often offered to those who had a high viral load (1.19 to 1.32 depending on the viral load quartile) or associated tuberculosis (2.49 [2,02-3,06]). The multivariate analysis maintains geographical origin as a differentiating factor concerning access to INSTI.
The duration of the first antiretroviral treatment (depending on the effectiveness) was influenced by the nature of the initial treatment, the sex, the existence of tuberculosis and the initial viral load. Geographical origin did not matter.
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