Retention in HIV care and immunovirological outcomes among migrants and non-migrants: A 24-year cohort study in Barcelona.

BACKGROUND

Migration affects HIV outcomes; even with universal antiretroviral therapy (ART), migrant people living with HIV (PLWH) in Spain show worse immunovirological responses and retention in care.

METHODS

A retrospective longitudinal study of 8398 PLWH followed from 2000 to 2023 was conducted at Hospital Clínic of Barcelona; 4566 (54%) were migrants. Mixed-effects and Cox models assessed immunovirological outcomes, retention, and loss to follow-up.

RESULTS

Migrants were younger (median 34 vs 37) and more often male (92% vs 85%) and transgender (11% vs 1%). The baseline median cluster of differentiation 4 (CD4) was 413 cells/mm³. In 2009-2014, both treatment-naïve and treatment-experienced migrants had lower CD4 counts and immune recovery than non-migrants. In 2015-2023, treatment-naïve migrants showed reduced CD4 in the first 2 years of ART, and treatment-experienced migrants had lower CD4 and lower viral suppression (odds ratio: 0.33, 95% confidence interval [CI] 0.21-0.53). Retention at 2, 5, and 10 years was 78.2%, 67.3%, and 55.9% respectively, and was lower in migrants (51.4% vs 59.9% at 10 years). Migrant status was associated with LTFU (adjusted hazard ratio 1.31, 95% CI 1.20-1.43), and also low education, injecting drug use, transgender identity, and <1 year length residence.

CONCLUSIONS

Migrants with HIV had poorer immune recovery and higher LTFU than non-migrants; thus, addressing social differences is critical to meet the 95-95-95 targets.