XVIII International AIDS Conference

Abstract

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Differences in time from HIV seroconversion to HAART initiation according to geographical origin

I. Jarrin1, J. Gill2, R. Geskus3, L. Meyer4, G. Touloumi5, M. Prins6, O. Hamouda7, S. Perez-Hoyos8, K. Porter9, J. del Amo1, CASCADE

1Instituto de Salud Carlos III, Centro Nacional Epidemiologia, Madrid, Spain, 2University of Alberta, Alberta, Canada, 3Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands, 4Hopital de Bicetre, Paris, France, 5Athens University Medical School, Athens, Greece, 6Netherlands Institute for Health Services, Amsterdam, Netherlands, 7Robert Koch Institut, Berlin, Germany, 8Cresib, Barcelona, Spain, 9Medical Reseach Council, London, United Kingdom

Background: We examined differences by geographical origin in time to HAART initiation from HIV seroconversion (SC)
Methods: We used CASCADE data on geographical origin and, if missing, derived it for each individual from country of origin/birth or nationality, and classified as: WE (EU,North America,Australia/New Zealand), NAME (North Africa/Middle East), SSA (Sub-Saharan Africa), LA (Caribbean/South/Central America) and IND (Indian subcontinent/SE Asia). Analyses were restricted to people seroconverting after 1/1/97.The effect of geographical origin on time to HAART from SC was assessed using Cox proportional models allowing for late-entry, adjusted for sex, age at SC, exposure category, calendar year of SC, AIDS diagnosis prior to enrolment and having had symptomatic acute infection, and stratified by cohort. Patients not known to have started HAART were censored on the earliest of date of death, date last assessed for ART or 6/30/08
Results: Of 5571 seroconverters, 87% were from WE, 1% NAME, 8% SSA, 3% LA and 1% IND. Median time to HAART from SC was 1.3 years, ranging from 0.42 to 3.62 in SSA and LA, respectively, p< 0.001. In adjusted analyses, seroconverters from SSA had a higher risk of HAART initiation than those from WE (aHR:1.47, 95%CI:1.25-1.73). The overall median CD4 cell count (cells/µL) at HAART initiation was 270 (WE:278, NAME:258, SSA:238, LA:232, IND:195; p< 0.001). In the subset of 2537 patients with information on CD4 within 6 months from SC, median CD4 at SC was lower in seroconverters from SSA than in those from WE (363 vs 535). Adjustment for CD4 at SC reduced differences in time to HAART between seroconverters from SSA and those from WE (aHR:1.08, 95%CI:0.84-1.37)
Conclusions: Seroconverters from SSA were more likely to initiate HAART and at somewhat lower CD4 cell count than those from WE. These differences seem to be attributable to lower CD4 counts at seroconversion


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