Jueves, 21 de mayo de 2026

Perez-Molina JA, Suárez M, Sánchez MB, Tejerina F, Peñaranda M, Vera M, Goenaga MÁ, Bernal E, Peña I, Moreno S, Jarrín I, CoRIS. 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. 2026

"As migrants represent a growing share of HIV diagnoses in Spain, persistent gaps in late diagnosis, retention, and treatment response call for more targeted prevention and care strategies." - Dr José Antonio Pérez Molina

Summary:

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.

Why do you highligth this publication?

Migrants accounted for a growing share of HIV diagnoses in Spain. Western migrants generally had outcomes similar to those of native-born people, but late diagnosis persisted among Sub-Saharan Africans and Latin Americans. Despite similar access to ART and timely treatment initiation, migrants had higher rates of loss to follow-up, and Sub-Saharan Africans showed poorer viral and CD4 responses.