Characteristics and response to antiretroviral therapy of
HIV-1-infected patients born in Africa and living in France
G Breton,1* C Lewden,2B Spire,3D Salmon,4F Brun-Ve ´zinet,5M Duong,6C Allavena,7C Leport,1R Salamon2and the
APROCO COPILOTE ANRS CO8 Study Groupw
1Service de Maladies Infectieuses et Tropicales B, CHU Bichat, Universite ´ Paris VII,2INSERM U593, Bordeaux,3INSERM,
U379, Marseille,4Service de Me ´decine Interne, Ho ˆpital Cochin, Paris,5Laboratoire de Virologie, Ho ˆpital Bichat, Paris,
6Service de Maladies Infectieuses, Ho ˆpital du Bocage, Dijon,7Service de Maladies Infectieuses, Ho ˆpital Ho ˆtel Dieu, Nantes,
The world-wide AIDS epidemic is reflected in Western Europe in an increasing number of
HIV-infected persons who originate from Africa. We describe the characteristics and response
to antiretroviral therapy (ART) of HIV-infected patients born in Africa and living in France.
Analysis of data from the (Anti PROte ´ase COhorte APROCO) cohort study of HIV-infected patients
initiating ART was carried out. Included in the study were 90 patients born in sub-Saharan Africa,
53 in North Africa and 771 in metropolitan France.
At baseline, there was a higher proportion of women and of the heterosexual transmission route of
infection among patients born in sub-Saharan Africa, a higher proportion of injecting drug users
among patients born in North Africa and a higher frequency of unemployment and of unstable
housing conditions among patients born in both sub-Saharan and North Africa as compared
with patients born in France. The median CD4 cell count was lower in patients born in both
sub-Saharan and North Africa (sub-Saharan Africa: 197 cells/mL; North Africa: 222 cells/mL) than
in patients born in France (307 cells/mL). Median HIV-1 viral loads were similar. After a median
follow-up time of 36 months (2506 patient-years), the Kaplan–Meier estimations of probability
of survival without new AIDS-defining events were not different. After 36 months of ART, in
multivariate analysis, median CD4 cell count, CD4/CD8 ratio and viral load were not statistically
different according to birthplace, but the median CD4 percentage was lower in patients born in both
sub-Saharan and North Africa. The adherence profiles were similar.
Although clinical response and adherence to ART did not appear to differ in patients according to
their birthplace, the reasons for the more advanced HIV infection observed at ART initiation among
patients born in Africa should be further investigated.
Keywords: access to treatment, Africa, ART, HIV
Received: 21 June 2006, accepted 19 October 2006
The majority of HIV-1-infected persons world-wide is
living in Africa . Access to antiretroviral therapy (ART)
there has begun to improve, and the first studies of
antiretroviral efficacy have shown encouraging results.
Immunological and virological response [2–4], resistance
emergence [5,6] and adherence levels [7,8] were found to
The authors have no commercial or other associations that might create a
conflict of interests.
*Present address: Service de Me ´decine Interne, Ho ˆpital Pitie ´ Salpe ´trie `re.
Correspondence: Professor Catherine Leport, Service de Maladies
Infectieuses et Tropicales, Ho ˆpital Bichat Claude Bernard, 46 rue Henri
Huchard, 75877 Paris, Cedex 18, France. Tel: 33 1 40 25 78 03; fax: 33 1 40
25 88 60; e-mail: email@example.com
wSee Appendix for members of the study group.
HIV Medicine (2007), 8, 164–170
r 2007 British HIV Association
Appendix: the APROCO-COPILOTE ANRS
CO8 study group
Principal investigators: C. Leport and F. Raffi.
Methodology: G. Che ˆne and R. Salamon.
Social sciences: J.-P. Moatti, J. Pierret and B. Spire.
Virology: F. Brun-Ve ´zinet, H. Fleury and B. Masquelier.
Pharmacology: G. Peytavin and R. Garraffo.
Other members: D. Costagliola, P. Dellamonica, C. Katlama,
L. Meyer, M. Morin, D. Salmon and A. Sobel.
Events Validation Committee
L. Cuzin, M. Dupon, X. Duval, V. Le Moing, B. Marchou, T.
May, P. Morlat, C. Rabaud and A. Waldner-Combernoux.
P. Bursachi, J. F. Delfraissy, J. Dormont and M. Garre ´.
Clinical Research Group
V. Le Moing and C. Lewden.
Clinical Centres (coordinators)
Amiens (Professor J. L. Schmit), Angers (Dr J. M.
Chennebault), Belfort (Dr J. P. Faller), Besanc ¸on (Professor
J. L. Dupond, Dr J. M. Estavoyer and Professor P. Humbert),
Bobigny (Professor A. Krivitzky), Bordeaux (Professors M.
Dupon, Longy-Boursier, P. Morlat and J. M. Ragnaud),
Bourg-en-Bresse (Dr P. Granier), Brest (Professor M. Garre ´),
Caen (Professor R. Verdon), Compie `gne (Dr Y. Domart),
Corbeil Essonnes (Dr A. Devidas), Cre ´teil (Professor A.
Sobel), Dijon (Professor H. Portier), Garches (Professor C.
Perronne), Lagny (Dr P. Lagarde), Libourne (Dr J. Ceccaldi),
Lyon (Professor D. Peyramond), Meaux (Dr C. Allard),
Montpellier (Professor J. Reynes), Nancy (Professor T. May),
Nantes (Professor F. Raffi), Nice (Professors J. P. Cassuto
and P. Dellamonica), Orle ´ans (Dr P. Arsac), Paris (Professor
E. Bouvet, Professor F. Bricaire, Professor P. Bergmann,
Professor J. Cabane, Dr G. Cessot, Professor P.M. Girard,
Professor L. Guillevin, Professor S. Herson, Professor C.
Leport, Professor M. C. Meyohas, Professor J. M. Molina,
Professor G. Pialoux and Professor D. Salmon), Poitiers
(Professor B. Becq-Giraudon), Reims (Professor R. Jaus-
saud), Rennes (Professor C. Michelet), Saint-Etienne
(Professor F. Lucht), Saint-Mande ´ (Professor T. Debord),
Strasbourg (Professor J. M. Lang), Toulon (Dr J. P. De
Jaureguiberry), Toulouse (Professor B. Marchou) and Tours
(Professor J. M. Besnier).
Data monitoring and statistical analysis
C. Alfaro, F. Alkaied, C. Barennes, S. Boucherit, A. D.
Bouhnik, C. Brunet-Franc ¸ois, M. P. Carrieri, M. Courcoul, F.
Couturier, J. L. Ecobichon, M. Franc ¸ois, L. Iordache, V.
Journot, P. Kurkdji, R. Lassalle, J. P. Legrand, E. Lootvoet, E.
Pereira, M. Pre ´au, C. Protopopescu, J. Surzyn, A. Taieb, F.
Tourteau, V. Villes and H. Zouari.
Agence Nationale de Recherches sur le Sida (ANRS, Action
Coordonne ´e n17).
Colle `ge des Universitaires de Maladies Infectieuses et
Tropicales (CMIT)(ex Association
Pathologie Infectieuse et Tropicale-APPIT), Sidaction, Ensem-
ble contre le Sida, Abbott, Boehringer-Ingelheim, Bristol-
Myers Squibb, Glaxo-SmithKline, Merck Sharp et Dohme and
170 G Breton et al.
r 2007 British HIV Association HIV Medicine (2007) 8, 164–170