HIV Care in Ukrainian Migrants in Two European Countries: All the Same?
Kathrin van BremenMiłosz ParczewskiMalte Benedikt MoninMagdalena Leszczyszyn-PynkaStefan SchlabeFranciszek LenkiewiczMalwina Karasińska-CieślakJan-Christian WasmuthMagdalena Witak-JędraSven BreitschwerdtJürgen K RockstrohDmytro ZhyvytsiaChristoph BoeseckeDaniel ChoberBogusz Jan Aksak-WąsPublished in: Pathogens (Basel, Switzerland) (2024)
Introduction: War in Ukraine prompted an enormous refugee influx into Europe, including approximately 4200 people with HIV. The unique healthcare features of Ukrainian refugees living with HIV were compared between two infectious disease departments in Bonn, Germany, and Szczecin, Poland. Methods: This is a retrospective study on 161 people living with HIV (PLWH) refugees from Ukraine seeking care in Bonn (n = 30) and Szczecin (n = 131) between April 2022 and May 2023. Demographic, virologic, immunologic, and coinfection data were analyzed. Results: The majority of the studied individuals were female: 64% (n = 84) in Szczecin and 60% (n = 18) in Bonn. The main HIV transmission mode was heterosexual sex in 73.5% (n = 114). All were on combined antiretroviral therapy (cART) on arrival, primarily on the TLD regimen (TDF/3TC/DTG) (68.4%, n = 106). In Germany, cART was most frequently switched to BIC/TAF/FTC in 83.4% (n = 25); in Poland, the most common combination was TDF/FTC + DTG (58%, n = 76). A prevalence of replicating hepatitis C was in 11.7% (n = 15), and that for chronic hepatitis B (HBV) was in 4.7% (n = 4). History of past tuberculosis was reported in 16.9% (n = 14, Poland, and n = 7, Germany). Follow-up after 6 months showed immunological reconstitution with a mean increase of CD4+ of 10 (IQR: -69.5-120.5) cells/µL in Poland and 51.5 (IQR: -22.5-135.5) cells/µL in Germany; p = 0.04. Virologic suppression (<40 HIV-RNA/mL) was high in care entry (n = 62; 98%) for Poland, and n = 26 (92.6%) for Germany, and suppression was achieved in the majority of patients in the 6-month control (89.7% in Poland vs. 95.7% in Germany). Conclusions: Health challenges posed by war migration extend beyond HIV to coinfections as HBV, HCV, and tuberculosis give an indication for a broader search for coinfections, often less common in the new country.
Keyphrases
- antiretroviral therapy
- hiv infected
- hiv aids
- human immunodeficiency virus
- hiv positive
- healthcare
- hiv infected patients
- hepatitis c virus
- hepatitis b virus
- induced apoptosis
- mental health
- hiv testing
- end stage renal disease
- palliative care
- infectious diseases
- cell cycle arrest
- newly diagnosed
- chronic kidney disease
- public health
- risk factors
- emergency department
- pulmonary tuberculosis
- ejection fraction
- pain management
- cell death
- south africa
- machine learning
- health information
- big data
- chronic pain
- health promotion
- endoplasmic reticulum stress