Description
Background: HIV-related clinical, immunological and virological outcomes are influenced by social determinants, including lack of social support, communication barriers, poor housing, low educational level and stigma . Compared to native-born populations, international migrants arriving in Europe face severe socio-economic challenges that result in higher HIV prevalence and limited access to healthcare . Aim of this systematic review and meta-analysis is to explore HIV-related outcomes in migrants compared to native population in Europe.
Methods: A systematic review and meta-analysis was carried out to identify studies investigating HIV- related outcomes in migrants and native people living with HIV in Europe. Six investigators independently searched PubMed, SCOPUS, and Web of Science until October 2023, then screened titles and abstracts of all potentially eligible articles. The authors applied the eligibility criteria, considered the full texts. All studies reported incidence of HIV related outcomes in both migrant and native population. This meta-analysis was conducted in accordance with PRISMA guidelines .
Results: Among 817 papers initially screened, 19 were included, consisting of 105,393 participants comparing 68,834 natives and 32,155 migrants living with HIV participants who were followed up for a median of 84 months . As shown in Table 1, adjusted meta-regression showed that, compared to native population, migrants present lower mortality (RR 0.88 95% CI 0.75-1.04) and higher risk ratios for treatment discontinuation (RR 2.39 95% CI 1.49 to 3.29) loss to follow-up (RR 2.53 95% CI 1.41 to 4.53), AIDS or death (RR 0.66 95% CI 0.42 to 1.04) virological failure (RR 1.80 95% CI 1.25-2.60) and immunological failure RR 3.70 95% CI 2.17-12). Forest plots are shown in Figure 1 . In sub-analyses for WHO Regions, people originally from sub-Saharan Africa had higher risk for HIV-related adverse outcomes (Table 2).
Conclusions : Migrants living with HIV in Europe present lower mortality but higher risk for loss to follow-up, treatment discontinuation, virological and immunological failure. Interventions aimed to improved HIV care in migrants living in Europe are urgently needed.
Keywords
AIDS HIV migrants PLWH
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