{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:55:38Z","timestamp":1790610938028,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Migration policies increasingly shape the conditions of care for migrants living with HIV. In France, access to residence permits on medical grounds intersects with clinical practice, raising important ethical challenges. We describe a 29-year-old woman from Guinea living in France with HIV and severe obesity, with an irregular migration status. Although virologically stable on oral antiretroviral therapy, she requests a switch to a long-acting injectable regimen, motivated by both anticipated administrative implications and the desire for greater discretion. Through this case, we examine how therapeutic reasoning in HIV care may be shaped by legal and social determinants. Using the principlism framework of Beauchamp and Childress, complemented by Tronto's ethics of care, we highlight tensions related to justice, beneficence, non-maleficence, and autonomy. Uncertainty surrounding administrative decision-making may lead patients and clinicians to perceive treatment choices as influencing legal outcomes. Differences between oral and injectable regimens raise issues of equity, feasibility, and social impact. Risks related to treatment interruption, particularly in contexts of legal instability, further complicate clinical reasoning. This case underscores the need to integrate legal and social determinants into therapeutic reasoning and supports the development of guidance from professional societies to assist clinicians facing these complex decisions.<\/jats:p>","DOI":"10.1093\/cid\/ciag442","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:39:15Z","timestamp":1784029155000},"source":"Crossref","is-referenced-by-count":0,"title":["When Choosing Antiretroviral Therapy Meets Immigration Policy: An Ethical Analysis"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5468-0695","authenticated-orcid":false,"given":"Ava","family":"Diarra","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Vignier","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]},{"name":"Universit\u00e9 Sorbonne Paris Nord and Universit\u00e9 Paris Cit\u00e9, Inserm, UFR SMBH, IAME, UMR 1137 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Tantet","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Petit","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helo\u00efse","family":"Delagr\u00e8verie","sequence":"additional","affiliation":[{"name":"Department of Virology, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ornella","family":"Milleliri","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Bouchaud","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]},{"name":"Universit\u00e9 Sorbonne Paris Nord and Universit\u00e9 Paris Cit\u00e9, IRD, Inserm, CEPED, UMR 196 , Bobigny ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3013-9850","authenticated-orcid":false,"given":"Jeanne","family":"Goupil de Bouill\u00e9","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, AP-HP, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis, H\u00f4pital Avicenne and H\u00f4pital Jean Verdier , Bobigny ,","place":["France"]},{"name":"Laboratoire \u00c9ducations et Promotion de la Sant\u00e9,Universit\u00e9 Sorbonne Paris Nord, LEPS , Bobigny ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026092810593217800_ciag442-B1","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1016\/S2214-109X(18)30560-6","article-title":"Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis","volume":"7","author":"Ju\u00e1rez","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2026092810593217800_ciag442-B2","doi-asserted-by":"crossref","first-page":"e833","DOI":"10.1016\/S2352-3018(24)00210-8","article-title":"HIV-related outcomes among migrants living in Europe compared with the general population: a systematic review and meta-analysis","volume":"11","author":"Segala","year":"2024","journal-title":"Lancet HIV"},{"key":"2026092810593217800_ciag442-B3","author":"ECDC (European Centre for Disease Prevention and 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A systematic review","volume":"15","author":"Goupil de Bouill\u00e9","year":"2025","journal-title":"BMJ Open"},{"key":"2026092810593217800_ciag442-B6"},{"key":"2026092810593217800_ciag442-B7","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12910-020-00500-7","article-title":"Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France","volume":"21","author":"Cailhol","year":"2020","journal-title":"BMC Med Ethics"},{"key":"2026092810593217800_ciag442-B8","doi-asserted-by":"crossref","first-page":"S549","DOI":"10.1093\/cid\/ciac752","article-title":"Barriers to uptake of long-acting antiretroviral products for treatment and prevention of HIV in low- and middle-income countries (LMICs)","volume":"75","author":"Kityo","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2026092810593217800_ciag442-B9","author":"OCDE"},{"key":"2026092810593217800_ciag442-B10","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1097\/QAD.0000000000004302","article-title":"Case study of PEPFAR funding cuts on HIV infections and deaths: reversing hard-won gains","volume":"39","author":"Apollo","year":"2025","journal-title":"AIDS Lond Engl"},{"key":"2026092810593217800_ciag442-B11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/15265161.2019.1665402","article-title":"Principles of Biomedical Ethics: marking its fortieth anniversary","volume":"19","author":"Beauchamp","year":"2019","journal-title":"Am J Bioeth"},{"key":"2026092810593217800_ciag442-B12","first-page":"15","article-title":"An ethic of care","volume":"22","author":"Tronto","year":"1998","journal-title":"Gener J Am Soc Aging"},{"key":"2026092810593217800_ciag442-B13"},{"key":"2026092810593217800_ciag442-B14","doi-asserted-by":"crossref","first-page":"e332","DOI":"10.1016\/S2352-3018(23)00051-6","article-title":"Long-acting antiretrovirals and HIV treatment adherence","volume":"10","author":"Nachega","year":"2023","journal-title":"Lancet HIV"},{"key":"2026092810593217800_ciag442-B15","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1089\/apc.2021.0079","article-title":"Barriers and facilitators affecting the HIV care cascade for migrant people living with HIV in organization for economic co-operation and development countries: a systematic mixed studies review","volume":"35","author":"Arora","year":"2021","journal-title":"AIDS Patient Care STDs"},{"key":"2026092810593217800_ciag442-B16","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1097\/ACM.0000000000003498","article-title":"Following the script: an exploratory study of the therapeutic reasoning underlying physicians\u2019 choice of antimicrobial therapy","volume":"95","author":"Abdoler","year":"2020","journal-title":"Acad Med"},{"key":"2026092810593217800_ciag442-B17","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/medu.70123","article-title":"How postgraduate medical trainees conceptualise management reasoning: a qualitative study","volume":"60","author":"Parsons","year":"2026","journal-title":"Med Educ"},{"key":"2026092810593217800_ciag442-B18","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurpub\/ckaf042","article-title":"Barriers to healthcare access for irregular immigrants after their arrival in Spain: a systematic review","volume":"35","author":"Fagundo-Rivera","year":"2025","journal-title":"Eur J Public Health"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag442\/70775504\/ciag442.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag442\/70775504\/ciag442.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:59:39Z","timestamp":1790607579000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciag442\/8769915"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":18,"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag442","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"ciag442"}}