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Migrants from Sub-Saharan Africa in the Swiss HIV Cohort Study: access to antiretroviral therapy, disease progression and survival

Staehelin, Corneliaa; Rickenbach, Martinb; Low, Nicolaj; Egger, Martina; Ledergerber, Brunoc; Hirschel, Bernardd; D'Acremont, Valériee; Battegay, Manuelf; Wagels, Thomasg; Bernasconi, Enosh; Kopp, Christinei; Furrer, Hansjakoba; and the Swiss HIV Cohort Study

Epidemiology & Social

Objective: To examine the proportion of migrants from Sub-Saharan Africa entering the Swiss HIV Cohort Study (SHCS) and to compare these participants with participants from Northwestern Europe for access to antiretroviral therapy, progression to AIDS and survival.

Design: Prospective national cohort study of HIV-1-infected adults from seven HIV centres in Switzerland.

Methods: Trends in the proportion of participants from Sub-Saharan Africa were followed in 11 872 HIV-infected adults entering the SHCS from 1984 to 2001. Survival methods were used to compare uptake of antiretroviral therapy, survival and progression to AIDS in the 2684 participants from Sub-Saharan Africa and Northwest Europe enrolled from 1997–2001.

Results: There was a steady increase in the proportion of Sub-Saharan African participants over time, reaching 11.9% in 1997–2001. These participants were more likely to be younger, female, to have been infected by heterosexual intercourse and had lower CD4 cell counts at presentation. There were no differences between Sub-Saharan Africans and Northwest Europeans in uptake of triple antiretroviral therapy, progression to AIDS or survival up to 48 months after starting treatment. Tuberculosis was the most frequent AIDS-defining event in Sub-Saharan African patients.

Conclusions: There is no evidence that access to potent antiretroviral therapy is influenced by geographic origin of participants. The prognosis of Sub-Saharan African patients on triple therapy is equivalent to that of Northwest European patients. Future research should address wider issues about access to specialist health services for HIV-infected people from Sub-Saharan Africa.

From the aDivision of Infectious Diseases, University Hospital Berne, bData Center of the Swiss HIV Cohort Study Study, Lausanne, cDivision of Infectious Diseases, University Hospital Zurich, dDivision of Infectious Diseases, University Hospital Geneva, eDivision of Infectious Diseases, University Hospital Lausanne, fDivision of Infectious Diseases, University Hospital Basle, gDivision of Infectious Diseases, Cantonal Hospital St. Gall, hDivision of Infectious Diseases, Cantonal Hospital Lugano, iSwiss Federal Office of Public Health, Berne, Switzerland and the jDepartment of Social Medicine, University Bristol, UK.

See also p. 2261

Requests for reprints to: Dr H. Furrer, Division of Infectious Diseases, University Hospital Berne, CH-3010 Bern, Switzerland.

Received: 11 October 2002; revised: 27 February 2003; accepted: 15 April 2003.

© 2003 Lippincott Williams & Wilkins, Inc.