Lower immunologic response to cART in HIV-infected migrants from Sub-Saharan Africa compared to non-migrants in France: the ANRS-COPANA cohort

Background: Response to cART has been inconsistently shown to be poorer among non-native patients compared to natives in Western countries. Our objective was to compare immunologic response to cART in France between migrants from sub-Saharan Africa and French-natives, accounting for established determinants of response to cART and socioeconomic conditions.
Methods: We used data from the ANRS-COPANA multicenter prospective cohort made of a diversified sample of recently diagnosed HIV-1-infected adults, ART-naïve at baseline in 2004-2008. CD4 count (square root-transformed) kinetic within the 36 months following cART initiation was modelled using 2-slopes linear mixed-effects models. CD4 trends were compared between migrants from sub-Saharan Africa and French-natives accounting for age, gender and clinical, immuno-virological, therapeutic and socioeconomic characteristics at cART initiation.
Results: 437 participants (163 African migrants/274 French-natives) were considered. Median follow-up time from cART initiation was 33.1 months. Compared to French-natives, African migrants were more frequently women, younger, less educated and they experienced more adverse living conditions. African migrants were more likely than French-natives to present at HIV diagnosis with < 200 CD4/mm3 (36% versus 22%), and at cART initiation their mean CD4 count was lower (223/mm3 versus 276/mm3; difference ‑53/mm3, p=0.0001). Frequency of virological success did not differ between the two groups (83% versus 81% at 6 months after cART initiation). However, within the first 4 months of cART, CD4 count increased less steeply in African migrants than in French-natives (increase of 0.86 versus 1.05√CD4/month; p=0.02). As a result, 4 months after treatment initiation mean CD4 count reached 335/mm3 in African migrants and 432/mm3 in French-natives (difference ‑97/mm3, p< 0.0001). Clinical, immuno-virological, therapeutic and socioeconomic characteristics did not explain this difference. Subsequent increase in CD4 between 5 and 36 months of cART did not differ between the two groups. After 36 months of cART, mean CD4 count was 493/mm3 in migrants and 609/mm3 in French-natives (difference of ‑116/mm3, p< 0.0001).
Conclusion: Early immunologic response to cART is lower in HIV-infected sub-Saharan African migrants compared to non-migrants in France, despite a similar virological response. Established clinical and biological determinants of response to cART and socioeconomic conditions do not explain this difference.

R. Dray-Spira1,2, N. Billaudeau1,2, R. Seng3,4,5, M. Ghislain1,2, D. Salmon-Ceron6, G. Pialoux7, L. Cotte8, L. Camille3,4,5, L. Meyer3,4,5
1INSERM U1018, CESP, Epidemiology of Occupational and Social Determinants of Health, Villejuif, France, 2University of Versailles Saint-Quentin, Villejuif, France, 3INSERM U1018, CESP, Epidemiology of HIV and Sexually Transmitted Infections, Le Kremlin-Bicetre, France, 4University Paris Sud 11, Le Kremlin-Bicetre, France, 5AP-HP, Hopital de Bicêtre, Department of Epidemiology, Le Kremlin-Bicetre, France, 6AP-HP, Hopital Cochin, Department of Internal Medicine, Paris, France, 7AP-HP, Hopital Tenon, Department of Infectious Diseases, Paris, France, 8Hopital de la Croix-Rousse, Department of Infectious and Tropical Diseases, Lyon, France