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Birth country influences the choice of antiretroviral therapy in HIV-infected individuals: experience from a French HIV centre.

OBJECTIVES
To assess whether antiretroviral therapy (ART) prescriptions differ between naive and virally suppressed HIV patients born in France (PBFs) and in Sub-Saharan Africa (PBSSAs).


SETTING
Observational single-centre study.


METHODS
We included all PBFs and PBSSAs entered into care at Pitié-Salpêtrière Hospital, Paris, France, from 01/01/2000 to 31/12/2018, with plasma HIV-RNA>200 copies/mL. We first compared the initial ART in naive PBFs and PBSSAs. Second, we compared the last prescribed ART (including drug-reduced ART: daily 2-drug regimens, daily 1-drug regimens and intermittent 3-drug regimens) in virally suppressed PBFs and PBSSAs, by focusing on patients in care in 2018 with HIV-RNA <50 copies for at least 24 months. A uni- and multivariable logistic regression model was used to assess the impact of geographical origin on ART prescriptions.


RESULTS
A total of 1,944 naive patients were included (915 PBSSAs and 1,029 PBFs). PBSSAs were more frequently women, hepatitis B coinfected, with a lower pretherapeutic CD4 T-cell count, and most had tuberculosis at HIV diagnosis. After adjustment for confounders, PBSSAs were more likely to receive a first-line protease inhibitor-based regimen (OR 1.61, 95%CI 1.31-1.98), and less likely to receive an integrase inhibitor-based regimen (OR 0.61, 95%CI 0.42-0.88). Out of the 968 virally suppressed patients (431 PBSSAs and 537 PBFs), PBSSAs were less likely to receive drug-reduced ART, including two-drug regimens and intermittent three-drug regimens (OR 0.48, 95%CI 0.36-0.65).


CONCLUSIONS
Differences in ART prescriptions between PBSSAs and PBFs were not only explained by different clinical and virological situations. Personal motivations of doctors in choosing ART according to country of birth need to be explored.