Retention in HIV Care and Immunovirological Outcomes Among Migrants and Non-Migrants: A 24-Year Cohort Study in Barcelona

BACKGROUND: Migration affects HIV outcomes; even with universal antiretroviral therapy (ART), migrant people living with HIV (PLWH) in Spain show worse immunovirological responses and retention in care. METHODS: Retrospective longitudinal study of 8,398 PLWH followed from 2000-2023 at Hospital Clínic of Barcelona; 4,566 (54%) were migrants. Mixed-effects and Cox models assessed immunovirological, retention and loss to follow-up (LTFU). RESULTS: Migrants were younger (median 34 vs. 37), more often male (92% vs. 85%) and transgender (11% vs. 1%). Baseline median CD4 was 413 cells/mm³. In 2009-2014, both treatment-naïve and treatment-experienced migrants had lower CD4 counts and immune recovery than non-migrants. In 2015-2023, treatment-naïve migrants showed reduced CD4 in the first two years of ART, and treatment-experienced migrants had lower CD4 and lower viral suppression (OR: 0.33, 95% CI 0.21-0.53). Retention at 2, 5, and 10 years was 78.2%, 67.3%, and 55.9%, was lower in migrants (51.4% vs. 59.9% at 10 years). Migrant status was associated with LTFU (aHR: 1.31, 95% CI 1.20-1.43), also low education, injecting drug use, transgender identity, and <1 year length residence. CONCLUSIONS: Migrants with HIV had poorer immune recovery and higher LTFU compared with non-migrants, addressing social differences are critical to meet the 95-95-95 targets.