Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France

Abstract

Objectives: We aimed to examine the association of the country of birth and the other patients’ characteristics with the prescription of two-drug regimens (2DRs) in virally suppressed people with HIV (PWH) in France. Design: Observational study conducted from the national Dat’AIDS prospectively collected database. Methods: We included all adults who were actively in care on 31 December 2020 in 26 French centers, with an HIV plasma viral load (pVL) <50 copies/ml for at least 6 months while on antiretroviral therapy (ART). Patients with chronic hepatitis B were excluded because they are not eligible to 2DRs. Univariate and multivariate logistic regressions were built to analyze relationships between patients’ characteristics and receiving a 2DR. Results: We analyzed data from 28 395 PWH: 41.7% men who have sex with men, 31.7% women and 26.5% heterosexual men; 35% born abroad. Median age was 53 years [interquartile range (IQR) 44–60]; ART duration 14 years (8–23); duration of virological suppression 87 months (42–142). 2DRs (mainly dolutegravir/rilpivirine, 53.8%, or dolutegravir/lamivudine, 41.7%) were prescribed in 16.3% of the patients and were less common in the ‘born abroad’ group (18.9% versus 11.5%). The multivariate model showed that individuals born in France were more likely to receive a 2DR [adjusted odds ratio (aOR): 1.62 [1.50–1.74]], independently of other characteristics. Older PLWH and those with higher CD4+ T-cell counts were also more likely to receive a 2DR. Conclusion: Despite unrestricted access to ART in France, independently from HIV disease parameters, PWH born abroad were less likely to receive 2DRs as a maintenance regimen than those born in France. Qualitative data are needed to better understand physicians’ prescribing practices.