HIV acquisition after arrival in France among sub-Saharan African migrants living with HIV in Paris area. Estimations from the ANRS PARCOURS study

Background: HIV acquisition among sub-Saharan migrants living in Europe has long been considered to predominantly occur before migration because of generalized HIV epidemics in sub-Saharan African countries. Recent evidence suggests that a substantial proportion have acquired HIV while they were living in Europe. In the UK, this proportion was recently estimated at 31% using a CD4-based modelling approach. Such an estimate is not currently available for France.
Methods: We estimated the proportion of sub-Saharan migrants who acquired HIV infection after their arrival in France using life-event and clinical information on a random sample of HIV-infected hospital outpatients born in sub-Saharan Africa in Paris region. We assumed that HIV infection had probably been acquired in France if at least one of the following life-event criterion was fulfilled: i) HIV diagnosis >10 years after arrival in France, ii) ≥1 negative HIV test in France, iii) sexual debut after arrival in France. If none of these criteria was fulfilled, we estimated the duration from HIV infection based on first CD4 count measurement using statistical modelling. Infection was assigned in France if, out of 500 durations estimated for each individual, >50% (median scenario) or >95% (conservative scenario) fell within the period while individuals were living in France.

Flow chart - assignment of HIV acquisition
[Flow chart - assignment of HIV acquisition]

Results: Of the 898 HIV-infected adults born in sub-Saharan Africa included in the analysis, we estimated that 49% [95% confidence interval: 45-53] in the median scenario and 35% [31-39] in the conservative scenario acquired HIV while living in France. This proportion was lower for women than men (30% [25-35] versus 44% [37-51] in the conservative scenario) and increased with duration in France.

 Men    Women   
  NWeighted %95%CIp valueNWeighted %95% CIp value
Overall 34843.937.4-50.6 55030.025.1-35.4 
Age at arrival in France<25 y8478.165.5-87.1<0.00117154.146.5-61.5<0.001
 25-34 y13944.335.9-53.2 25124.517.7-32.8 
 35 y and more12519.813.0-28.8 1288.44.4-15.5 
Number of years in France prior to diagnosis0 to 213710.34.9-20.6<0.0012545.43.2-8.9<0.001
 3 to 54519.37.0-43.0 9323.418.6-29.0 
 6 to 93954.036.2-70.9 6752.536.3-68.3 
 10 or more10693.585.4-97.3 9586.077.0-91.9 
[ France HIV acquisition - conservative scenario]

Conclusions: The proportion of sub-Saharan African migrants having acquired HIV infection while living in France is high, highlighting the need for improved focused HIV prevention. This requires a better understanding of the determinants of HIV infection in France in this population.

A. Desgrees du Lou1, J. Pannetier1, A. Ravalihasy1, A. Gosselin1, V. Supervie2, N. Bajos3, F. Lert4, N. Lydie5, R. Dray-Spira2
1IRD, CEPED, Paris, France, 2INSERM, IPLESP, Paris, France, 3INSERM, CESP, Le Kremin Bicêtre, France, 4INSERM, CESP, Villejuif, France, 5INPES, Saint Denis, France