Mortality in Migrants Living with HIV in Western Europe (1997-2013)
BACKGROUND:
Many
migrants face adverse socioeconomic conditions and barriers to health services
that can impair timely HIV diagnosis and access to life-saving treatments. We
aimed to assess the differences in overall mortality by geographical origin in
HIV-positive men and women using data from COHERE, a large European
collaboration of HIV cohorts from 1997 to 2013.
METHODS:
In this
observational cohort study, we included HIV-positive, antiretroviral-naive
people accessing care in western Europe from COHERE. Individuals were eligible
if enrolled in a cohort that collected information on geographical origin or
ethnic origin from Jan 1, 1997, to March 19, 2013, aged 18-75 years, they had
available information about sex, they were not infected perinatally or after
the receipt of clotting factor concentrates, and were naive to combination
antiretroviral therapy at cohort entry. Migrants' origins were grouped into
seven regions: western Europe and similar countries (Australia, Canada, New
Zealand, and the USA); eastern Europe; North Africa and the Middle East;
sub-Saharan Africa; Latin America; the Caribbean; and Asia and the rest of
Oceania (excluding Australia and New Zealand). Crude and adjusted mortality
rate ratios were calculated by use of Poisson regression stratified by sex,
comparing each group with the native population. Multiple imputation with
chained equations was used to account for missing values.
FINDINGS:
Between
Oct 25, 1979, and March 19, 2013, we recruited 279 659 individuals to the
COHERE collaboration in EuroCoord. Of these 123 344 men and 45 877 women met
the inclusion criteria. Our data suggested effect modification by transmission
route (pinteraction=0·12 for men; pinteraction=0·002 for women). No significant
difference in mortality was identified by geographical origin in men who have
sex with men. In heterosexual populations, most migrant men had mortality lower
than or equal to that of native men, whereas no group of migrant women had
mortality lower than that in native women. High mortality was identified in
heterosexual men from Latin America and heterosexual women from the Caribbean. Compared with that in the native population, mortality in
injecting drug users was similar or low for all migrant groups.
INTERPRETATION:
Characteristics
of and risks faced by migrant populations with HIV differ for men and women and
for populations infected heterosexually, by sex between men, or by injecting
drug use. Further research is needed to understand how inequalities are
generated and maintained for the groups with higher mortality identified in
this study.
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