Mapping HIV infection and sex-based differences among sub-Saharan African migrants in Northeast Italy: a multicenter study.

HIV continues to disproportionately affect Sub-Saharan African (SSA) migrants in Italy, who often experience late diagnosis and complex clinical and social challenges. This multicenter cross-sectional study evaluated determinants of poor immunological and virological outcomes and sex-based differences among 762 SSA migrants living with HIV in the Veneto, Friuli Venezia Giulia and Trentino Alto Adige regions (northeast Italy). Data on demographic, clinical, and social factors were collected from ten Infectious Diseases Centers between January and August 2023. Sex-based differences in clinical and socio-demographic characteristics were assessed using bivariate analyses. Univariate and multivariable logistic regression analyses were performed to evaluate determinants of immunological and virological outcomes, adjusting for relevant covariates. Late HIV diagnosis affected over two-thirds of participants. Despite high antiretroviral therapy coverage, only 38.3% achieved full virological suppression, while 60.6% had HIV-RNA < 200 copies/mL. Temporary residence permits were significantly associated with detectable viremia, underscoring the role of social and structural vulnerability on treatment outcomes. Females, who represented the majority of the cohort, had higher unemployment and longer HIV infection duration but better immunological profiles and fewer coinfections than males. Comorbidities, including psychiatric conditions, were similarly prevalent among both sexes, yet females accessed psychological support more frequently. These findings highlight the need for integrated, gender-sensitive healthcare and social interventions to improve early diagnosis, treatment continuity, and HIV outcomes in SSA migrant populations in Italy.