Health Profiles of Foreign-born Elderly Women with HIV in Italy

Stefania Arsuffi¹Eugenia Quiros Roldan¹Fabio Riccardo Colombo²Benedetta Fioretti¹Caterina Candela³Benedetto Maurizio Celesia⁴Micol Ferrara⁵Jovana Milic⁶Giuseppe Vittorio De Socio⁷Giordano Maddeddu⁸ANNA MARIA CATTELAN⁹Stefania Piconi¹⁰Paolo Bonfanti¹¹Agostino Riva¹²GIOVANNI GUARALDI⁶Stefano Calza²ANDREA CALCAGNO⁵Emanuele Focà^1*

• ¹Department of Clincal and Experimental Sciences, Unit of Infectious Diseases, University of Brescia and Spedali Civili Hospital, Brescia, Italy
• ²Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
• ³Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
• ⁴Division of Infectious Diseases, ARNAS Garibaldi, Catania, Italy
• ⁵Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
• ⁶Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
• ⁷Department of Medicine, Clinic of Infectious Diseases, University of Perugia, Perugia, Italy
• ⁸Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
• ⁹Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
• ¹⁰Infectious Diseases Unit, Alessandro Manzoni Hospital, Lecco, Italy
• ¹¹Fondazione IRCCS San Gerardo dei Tintori, Monza - University of Milano-Bicocca, Milano, Italy
• ¹²Third Division of Infectious Diseases, University of Milan, Ospedale L. Sacco, Milan and University of Milan, Milano, Italy

Background Ageing trajectories for foreign-born individuals and women living with HIV remain poorly defined globally. This study aimed to characterize foreign-born women living with HIV aged ≥65 years (FWLH) and compare them to age-matched Italian women (IWLH) and foreign-born men living with HIV (FMLH). Methods Data were drawn from the multicenter Italian geriatric HIV cohort (GEPPO). We described sociodemographic characteristics, viro-immunological status, comorbidities, and multidimensional geriatric assessment in FWLH. A complete case analysis was supplemented by multiple imputation using the mice package with the Predictive Mean Matching (PMM) method, and pooled estimates were derived from regression models, that included an interaction term for sex × birthplace. Results We included 330 participants: 285 (86.5%) women, 15 (4.5%) FWLH and 30 (9%) FMLH. Comparing FWLH to IWLH, lower CD4+/CD8+ ratio (beta -0.38; 95% confidence interval (CI) -0.79, 0.03; p-value=0.069) and percentage of CD4+ cell (beta -10; 95% CI -16, -4.1; p-value =0.001) and higher weight (beta 11; 95% CI 3.4, 18; p-value=0.004) and BMI (beta 3.8; 95% CI 0.57, 7.0; p-value=0.021) were observed. Comparing FMLH to FWLH, we found lower prevalence of multimorbidity (IRR 0.60, 95% CI 0.37, 0.98, p-value= 0.039) and osteoporosis, though risk difference for osteoporosis was not significant. In the interaction model, FWLH had a lower percentage of CD4+ cells (β = –0.38; 95% CI: –0.73, –0.02; p = 0.036). Conclusions FWLH in a geriatric cohort showed a profile of immune imbalance and higher weight, BMI, and multimorbidity; this may be possibly related to a worse metabolic profile and poorer access to care. However, there was no difference in virological response and antiretroviral therapies. Enhancing our understanding of older FWLH is crucial for promoting person-centered care a patient-centred care and healthy ageing in this population.