Later cART Initiation in Migrant Men from Sub-Saharan Africa without Advanced HIV Disease in France

OBJECTIVE To compare the time from entry into care for HIV infection until combination antiretroviral therapy (cART) initiation between migrants and non migrants in France, excluding late access to care. METHODS Antiretroviral-naïve HIV-1-infected individuals newly enrolled in the FHDH cohort between 2002-2010, with CD4 cell counts >200/μL and no previous or current AIDS events were included. In three baseline CD4 cell count strata (200-349, 350-499, ≥ 500/μL), we examined the crude time until cART initiation within three years after enrollment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrollment period, region of care, plasma viral load, and HBV/HBC coinfection. RESULTS Among 13338 individuals, 9605 (72.1%) were French natives (FRA), 2873 (21.4%) were migrants from sub-Saharan Africa/non-French West Indies (SSA/NFW), and 860 (6.5%) were migrants from other countries. Kaplan-Meier probabilities of cART initiation were significantly lower in SSA/NFW than in FRA individuals throughout the study period, regardless of the baseline CD4 stratum. After adjustment, the likelihood of cART initiation was respectively 15% (95%CI, 1-28) and 20% (95%CI, 2-38) lower in SSA/NFW men than in FRA men who had sex with men (MSM) in the 350-499 and ≥ 500 CD4 strata, while no difference was observed between other migrant groups and FRA MSM. CONCLUSION SSA/NFW migrant men living in France with CD4 >350/μL at entry into care are more likely to begin cART later than FRA MSM, despite free access to treatment. Administrative delays in obtaining healthcare coverage do not appear to be responsible.