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Publications

Journal Article Ahead of print

PubMed: 42119887 DOI: 10.1016/j.cmi.2026.05.004

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

Clin Microbiol Infect

Authors: Jose A Perez-Molina, Miguel Suárez-Robles, María Belén Sánchez-López, Francisco Tejerina, María Peñaranda, Mar Vera, Miguel Ángel Goenaga-Sánchez, Enrique Bernal-Morell, Ignacio Peña, Santiago Moreno, Inmaculada Jarrín

Affiliations

  • National Referral Centre for Tropical Diseases. Infectious Diseases Department. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
  • National Referral Centre for Tropical Diseases. Infectious Diseases Department. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Spain.
  • Unidad VIH, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain.
  • CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología Clínica y Enfermedades infecciosas. Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  • Servicio de Medicina Interna, Unidad de Infecciosas. Hospital Universitario Son Espases, Palma de Mallorca, Spain.
  • Centro Sanitario Sandoval. IdISSC. Hospital Clínico San Carlos, Madrid, Spain.
  • Servicio de Enfermedades Infecciosas. Hospital Universitario Donostia/Donostia Unibertsitate Ospitalea. Instituto de Investigación BioGipuzkoa, Donostia, Spain.
  • Instituto Murciano de Investigación Biosanitaria (IMIB). Sección de Enfermedades Infecciosas, Servicio de Medicina Interna. Hospital Universitario Reina Sofía, Murcia, Spain; Universidad de Murcia, Murcia, Spain.
  • National Referral Centre for Tropical Diseases. Infectious Diseases Department. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; Salud Entre Culturas, Madrid, Spain.
  • CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Spain; Infectious Diseases Department. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
  • CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Unidad de Coordinación de la cohorte CoRIS, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.

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), ART initiation within 3 months of cohort entry, virological suppression (VS; 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 (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 to 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). VS 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 late diagnosis and treatment-response persisted over time.

DISCUSSION

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. While ART initiation appears comparable, inequalities in treatment-response persist by ROI. Better strategies for prevention, early diagnosis, and care engagement are needed.

MeSH

Anti-Retroviral Agents, Microbiology, Parasitic Diseases, Diagnosis, Therapeutics, Communicable Diseases, Infections