Poorer outcomes for undocumented migrants in Italy

An Italian study shows that people who are in the country without the necessary authorisation or documents required by immigration rules (undocumented migrants) have poorer health outcomes than other people living with HIV.

Although undocumented migrants are able to access urgent and essential health care in Italy (including HIV treatment), the study shows that more support is needed to help vulnerable people stay in care.

The study looked at 885 people who began HIV care at a Milan hospital between 2001 and 2013. In line with national trends, one quarter of those starting treatment were migrants born overseas. A third of migrants were undocumented.

Half the migrants came from Latin America, with large numbers also coming from African countries. Many of those from Latin America were transgender women, who were frequently undocumented and may have faced other social challenges.

One year after starting treatment, 79% of Italian citizens were retained in medical care, compared to 83% of migrants with legal papers and 65% of undocumented migrants.

Of those still in care, 91% of Italian citizens had an undetectable viral load, compared to 81% of migrants with legal papers and 78% of undocumented migrants.

The researchers point to stigma, poverty and social marginalisation as challenges for migrants which make it harder to stick with HIV treatment.

Similar studies have not been done in the UK. Research shows that treatment outcomes for people of different ethnic groups are similar, but research comparing HIV outcomes according to immigration status has not been conducted in the UK.

Switching from efavirenz has no meaningful impact on cognitive function

The antiretroviral drug efavirenz can cause side-effects like sleep disturbance, vivid dreams, dizziness and memory problems in some people who take it. Doctors in Newcastle recently ran a study in which a small number of people who had been taking an efavirenz-based regimen for several years changed drugs, to lopinavir/ritonavir and other antiretrovirals.

As well as asking the 16 participants about their symptoms, the researchers also got participants to take a battery of tests of memory and mental processing to assess cognitive function. They were done before switching treatment and ten weeks later.

While changing treatment did appear to improve sleep quality, the tests showed that switching drugs had no impact on cognitive function, brain metabolites, or brain activity. Almost all the assessments performed before and after the treatment switch had comparable results.