Persistence of late HIV diagnosis and poorer response to antiretrovirals: a comparison between migrants and native-born people with HIV in Spain

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Pérez-Molina J.A.
  • Suárez-Robles M.
  • Sánchez-López M.B.
  • Goenaga-Sánchez M.Á.
  • Bernal E.
  • Peña I.
  • Moreno C.
  • Rava M.
  • Izquierdo R.
  • Marco C.
  • Gómez-García T.
  • Juárez R.
  • Portilla I.
  • Merino E.
  • Agea I.
  • Sánchez-Payá J.
  • Rodríguez J.C.
  • Giner L.
  • Reus S.
  • Boix V.
  • Torrus D.
  • Pérez V.
  • Portilla J.
  • Pinargote H.
  • Alemán M.R.
  • Lirola A.L.
  • García D.
  • Díaz-Flores F.
  • Alonso M.M.
  • Pelazas R.
  • Hernández M.I.
  • Romero L.
  • Bethencourt A.
  • Rodríguez D.
  • Asensi V.
  • Magadan R.C.
  • Fernández L.
  • Díaz-Arias J.
  • Pulido F.
  • Bisbal O.
  • Hernando M.A.
  • Rial D.
  • de Lagarde M.
  • Pinto A.
  • Bermejo L.
  • Santacreu M.
  • Navarro R.
  • Torres J.M.
  • Iribarren J.A.
  • Aramburu M.J.
  • Camino X.
  • Goenaga M.Á.
  • Bustinduy M.J.
  • Azkune H.
  • Ibarguren M.
  • Kortajarena X.
  • Álvarez-Rodriguez I.
  • Gil L.
  • Carmona-Torre F.
  • Carlos A.B.
  • Sanz M.L.
  • Pavón C.N.
  • Robledano C.
  • Masiá M.
  • Padilla S.
  • Pascual R.
  • Galiana A.
  • García J.A.
  • Barber X.
  • Abellán J.G.
  • Telenti G.
  • Botella Á.
  • Mascarell P.
  • Carvajal M.
  • García-Sánchez L.
  • Ena N.
  • López L.
  • Vallejo J.
  • Gonzalo-Jiménez N.
  • Ruiz M.
  • Ledesma C.
  • Espinosa M.
  • Quiles A.
  • Andreo M.
  • Alcalde M.D.M.
  • Hernández R.
  • Escribano J.C.
  • Menchi M.
  • Navarro M.D.M.G.
  • Muga R.
  • Sanvisens A.
  • Fuster D.
  • López Bernaldo de Quirós J.C.
  • Gutiérrez I.
  • Ramírez M.
  • Gijón P.
  • Aldamiz-Echevarría T.
  • Tejerina F.
  • Diez C.
  • Fanciulli C.
  • Corral S.
  • Peraire J.
  • Rull A.
  • Martí A.
  • Viladés C.
  • Villar B.
  • Guillem L.
  • Chafino S.
  • Flores M.
  • Calabuig E.
  • Fernández J.
  • Blanes R.
  • Sánchez J.
  • González-García J.
  • Delgado-Hierro A.
  • Arribas J.R.
  • Arribas V.
  • Bernardino J.I.
  • Busca C.
  • Cano-Smith J.
  • Cadiñanos J.
  • Castro J.M.
  • Escosa L.
  • Falces I.
  • Herranz P.
  • Hontañón V.
  • González-Baeza A.
  • Martín-Carbonero M.L.
  • Mayoral M.
  • Micán R.
  • de Miguel R.
  • Montejano R.
  • Montes M.L.
  • Ramos-Ruperto L.
  • Rodés B.
  • Sainz T.
  • Sendagorta E.
  • Valencia E.
  • Arcos M.D.M.
  • de Gea Grela A.
  • López C.O.
  • Blanco J.R.
  • Pérez-Martínez L.
  • Ibarra V.
  • Metola L.
  • Sanz M.
  • Melús E.
  • Gil D.
  • Caballero R.
  • Caudevilla M.A.
  • Monge M.E.
  • Martinez M.
  • Jaén A.
  • Cairó M.
  • Martinez-Lacasa J.
  • Font R.
  • Gisbert L.
  • Rivero M.
  • Gracia M.
  • Ibero C.
  • Repáraz J.
  • Baigorria F.
  • Miqueleiz A.
  • Huerta M.F.
  • Navarro G.
  • Isbert S.C.
  • Vilasaro M.N.
  • Delgado J.F.
  • Santos I.D.L.
  • Santos A.D.L.
  • García-Fraile L.
  • Martín E.
  • Sánchez-Cerrillo I.
  • Barrios A.
  • Bautista A.
  • Sáez C.
  • Ciudad M.
  • Gutiérrez Á.
  • García M.A.
  • Rubio V.S.
  • Campo S.D.
  • Casado J.L.
  • Dronda F.
  • Pérez M.J.
  • Serrano-Villar S.
  • Vivancos M.J.
  • Martínez-Sanz J.
  • Vallejo A.
  • Sánchez-Conde M.
  • Hermida J.M.
  • De La Torre Tarazona E.
  • Moreno E.
  • Pedraza L.M.
  • García C.D.
  • Díaz J.
  • García A.
  • Ron R.
  • Alcaraz A.
  • Bravo J.
  • Muñoz Á.
  • Tomás C.
  • Oliver E.
  • García E.
  • González R.
  • Guijarro E.
  • Martínez R.
  • Hernández M.D.
  • García F.
  • Martínez C.
  • Medina L.M.
  • Álvarez M.
  • Chueca N.
  • Vinuesa D.
  • de Salazar A.
  • Fuentes A.
  • Guirao E.
  • Ruiz-Sancho A.
  • Anguita F.
  • Faro N.
  • Chaves L.
  • Illescas M.
  • Muñoz P.
  • Pérez L.
  • Del Romero J.
  • Raposo M.
  • Puerta T.
  • Vera M.
  • Ballesteros J.
  • Baza B.
  • Orviz E.
  • Robledo M.S.
  • Villán L.D.
  • Navarro R.L.
  • Yeguas I.A.
  • Antela A.
  • Losada E.
  • Riera M.
  • Peñaranda M.
  • Ribas M.A.
  • Campins A.A.
  • Garcia-Gasalla M.
  • Fanjul F.J.
  • Murillas J.
  • Martin-Pena L.
  • Artigues F.
  • Pinecki S.
  • Santos J.
  • López-Jódar M.
  • Gómez-Ayerbe C.
  • Viciana I.
  • Palacios R.
  • López-Cortés L.F.
  • Espinosa N.
  • Roca C.
  • Llaves S.
  • Herreros M.
  • Sotomayor C.
  • Tiraboschi J.M.
  • Imaz A.
  • Saumoy M.
  • Fernandez A.
  • Costa J.V.
  • Gamito D.M.
  • Curran A.
  • Falcó V.
  • Navarro J.
  • Burgos J.
  • Suanzes P.
  • Descalzo V.
  • Álvarez P.
  • Planas B.
  • Sanchíz M.
  • Monforte A.
  • Olalla J.
  • Pérez J.
  • Arco A.D.
  • Torre J.D.L.
  • Prada J.L.
  • Martínez O.J.
  • Martinez L.
  • Vera F.J.
  • García J.
  • Alcaraz B.
  • Martínez S.G.
  • García P.C.
  • Mena Á.
  • Pernas B.
  • Vázquez P.
  • López S.
  • Castelo B.
  • Ibarra S.
  • García G.
  • Mirena J.
  • Ferrero O.L.
  • López J.
  • Peña M.D.L.
  • López M.
  • López I.
  • Lombide I.
  • Polo V.
  • de Miguel J.
  • Estevez B.R.
  • Aguirre M.G.
  • Barberá Gracia M.J.
  • Tobarias M.V.
  • Izuzquiza I.
  • Galera C.
  • Fernández M.
  • Albendin H.
  • Castillo A.
  • Iborra A.
  • Moreno A.
  • Merlos M.A.
  • Ortuño A.
  • Amador C.
  • Pasquau F.
  • Gil C.
  • Algado J.T.
  • Suarez-García I.
  • Malmierca E.
  • González-Ruano P.
  • Ruiz M.P.
  • Balsalobre L.
  • Somodevilla Á.
  • Martínez R.F.
  • López M.D.L.V.
  • Omar M.
  • Herrero C.
  • Alberto de Zárraga M.
  • Pérez D.
  • Tarrazo C.T.
  • Becares J.V.
  • Estrada V.
  • Cabello N.
  • Núñez M.J.
  • Pérez-Somarriba J.
  • Homen R.
  • Muñoz A.
  • Barrado J.
  • Carralon M.
  • Sanz N.
  • Olmedo S.
  • Górgolas M.
  • Cabello A.
  • Álvarez B.
  • Prieto L.
  • Al-Hayani A.
  • Carrillo I.
  • López de las Heras M.
  • Sanz J.
  • Hernández C.
  • Novella M.
  • Galindo M.J.
  • Gómez S.P.
  • Ferrer A.
  • Román A.R.
  • Juárez A.R.
  • López P.
  • Frias M.
  • Camacho Á.
  • Pérez I.
  • Corona D.
  • Caballero J.M.
  • Torres L.R.
  • Carrasco Á.
  • Marín M.G.
  • Casares M.
  • Muñoz L.R.
  • Rodríguez-Rosado Martinez-Echevarría R.
  • Torres R.
  • Sánchez J.M.
  • Rincón P.
  • Real L.M.
  • Corma A.
  • Martín J.
  • Pérez A.
  • Morano L.
  • Miralles C.
  • Ocampo A.
  • Alonso J.
  • Martínez I.
  • López A.
  • Dueñas C.
  • López M.D.L.F.
  • Novoa C.
  • Telleria P.
  • García de Vicuña M.
  • García S.G.
  • Fernández R.G.
  • Valls C.N.
  • Du J.
  • Blanco A.M.
  • Aldea I.A.
  • Cañas-Ruano E.
  • Canepa C.
  • Giralt N.G.
  • Moreno S.
  • Jarrín I.
  • Dalmau D.
  • Navarro M.L.
  • González M.I.
  • Garcia F.
  • Poveda E.
  • ribarren O.A.
  • Gutiérrez F.
  • Rubio R.
  • Vidal F.
  • Berenguer J.
  • González J.
  • Muñoz-Fernández M.Á.
  • Centres and investigators involved in CoRIS cohort
  • CoRIS Executive Committee

Grupos

Abstract

Objectives Migrants living with HIV face barriers to accessing and staying in care, potentially worsening outcomes. We compared key HIV care continuum indicators by region of origin (ROI) overall/by sex and assessed whether disparities changed over time. Methods We included adults with HIV enrolled in the Spanish CoRIS cohort (2004–2023). Outcomes were late diagnosis (LD; CD4 <350 cells/µL or AIDS at enrolment), antiretroviral treatment (ART) initiation within 3 months of cohort entry, virological suppression (viral load <50 copies/mL), and CD4 change at 48 weeks after ART initiation. We assessed associations between ROI and outcomes using multivariable models and tested temporal trends by including region-by-calendar-period interactions. Results Among 20 215 participants, 54.1% were from Spain and 45.9% were born abroad. The proportion of people born abroad increased from 37.1% (2004) to 59.3% (2023), mainly driven by Latin Americans (LA). LD was more frequent among LA (adjusted OR [aOR] 1.58; 95% CI 1.44–1.73), Sub-Saharan Africans (SSA) (1.43; 1.24–1.64), and other regions (1.22; 1.05–1.41) compared with people born in Spain. Among men, LD was higher in LA and SSA; among women it was higher only in LA. Overall, ART initiation within 3 months did not differ, although LA men had lower odds in 2019–2023 (aOR 0.60; 0.37–0.95). Virological suppression at 48 weeks was lower only in SSA men (aOR 0.55; 0.41–0.75). CD4 recovery was reduced in SSA (adjusted mean difference -77.0; 95% CI -94.9 to -59.1) and LA (-21.3; -30.6 to -11.9). Disparities in LD and treatment-response persisted over time. Conclusions Migrants account for a growing share of new HIV diagnoses in Spain. LD remains more common among SSA and LA, and healthcare access policy changes have not ameliorated these gaps. Although ART initiation appears comparable, inequalities in treatment-response persist by ROI. Better strategies for prevention, early diagnosis, and care engagement are needed. © 2026 European Society of Clinical Microbiology and Infectious Diseases.

Datos de la publicación

ISSN/ISSNe:
1198-743X, 1469-0691

CLINICAL MICROBIOLOGY AND INFECTION  ELSEVIER SCI LTD

Tipo:
Article
Páginas:
1311-1321
PubMed:
42119887
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
3,111 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Adult; Anti-HIV Agents; CD4 Lymphocyte Count; Delayed Diagnosis; Female; HIV Infections; Humans; Male; Middle Aged; Spain; Transients and Migrants; Viral Load; bictegravir; CD4 antigen; cobicistat; darunavir; dolutegravir; elvitegravir; emtricitabine; Human immunodeficiency virus proteinase inhibitor; integrase inhibitor; lamivudine; nonnucleoside reverse transcriptase inhibitor; raltegravir; rilpivirine; ritonavir; RNA directed DNA polymerase inhibitor; tenofovir alafenamide; tenofovir disoproxil; anti human immunodeficiency virus agent; access to treatment; adult; Article; CD4 lymphocyte count; clinical outcome; cohort analysis; comparative study; controlled study; delayed diagnosis; female; health care disparity; human; Human immunodeficiency virus infection; indigenous people; major clinical study; male; migrant; persistent virus infection; prospective study; social determinants of health; South and Central America; Spain; sub-Saharan African; treatment response; virus load; diagno

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