{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T02:35:00Z","timestamp":1767926100033,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>In Israel, irregular migrants (IMs) living with human immunodeficiency virus (HIV-1) that have no access to regular health insurance are provided with HIV-1-related health coverage under a public\u2013private partnership (PPP) program initiated by the Ministry of Health in 2014. Here we characterized IMs referred to the PPP in 2019\u20132024 and used a linear mixed-effects model to follow up their CD4 and HIV-1 viral load (VL) counts for a median period of 16 months. Subtypes, resistance mutations and phylogenetic relationships were determined in all cases with viral failure and in selected cases with available blood remains. A total of 231 of 238 referred to the PPP initiated antiretroviral treatment (ART) with nucleoside reverse transcriptase inhibitors (NRTIs) and either non-nucleoside reverse transcriptase inhibitors (NNRTIs, 61.5%, 142\/231) or protease inhibitors (PIs, 38.5%, 89\/231). Irrespective of the treatment regimen, all these individuals increased their CD4 and decreased their VL trajectories over time (p &lt; 0.001). However, mixed model analysis revealed two classes of CD4 trajectory patterns. Comparison between these two patterns revealed that Class-1 individuals started with lower initial CD4 counts compared to Class-2 individuals (median of 115 cells\/mm3, IQR 70\u2013171 compared to median of 312 cells\/mm3, IQR 104\u2013510, p &lt; 0.001) and experienced slower recovery compared to Class-2. Most Class-1 individuals originated from Africa (78% vs. 52%, p = 0.016). Treatment failure was observed in 5.6% of all individuals receiving treatment under the program. Sequencing analysis, enabled in 23% of the treated cohort, revealed that the reverse transcriptases (RT) M184V (13%) and K103N (7.4%) were the most prevalent mutations. Conclusively, while treatment was not consistent with current recommendations for first-line therapy, the virological and immunological response of most patients was favorable and the prevalence of cases with resistance mutations was not higher than that identified in people living with HIV-1 who are covered by the national health insurance. Despite the limitations of the PPP, this program may provide a unique therapeutic opportunity for IMs with HIV-1.<\/jats:p>","DOI":"10.3390\/v17121566","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:03:02Z","timestamp":1764594182000},"page":"1566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Accessing HIV Care to Irregular Migrants in Israel, 2019\u20132024"],"prefix":"10.3390","volume":"17","author":[{"given":"Tali","family":"Wagner","sequence":"first","affiliation":[{"name":"Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem 9438317, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3458-1611","authenticated-orcid":false,"given":"Zohar","family":"Mor","sequence":"additional","affiliation":[{"name":"Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem 9438317, Israel"},{"name":"Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaakov","family":"Dickstein","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit and HIV Clinics, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Turner","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel"},{"name":"Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eynat","family":"Kedem","sequence":"additional","affiliation":[{"name":"Immunology Unit, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Rappaport Faculty of Medicine, Institute of Technology, Technion, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4716-1293","authenticated-orcid":false,"given":"Itzchak","family":"Levy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel"},{"name":"Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anat","family":"Wieder-Finesod","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel"},{"name":"Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hila","family":"Elinav","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hadassah Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel"},{"name":"Hadassah Medical Center, Jerusalem 9112102, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim Nasser","family":"Eddin","sequence":"additional","affiliation":[{"name":"Hadassah Medical Center, Jerusalem 9112102, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Olshtain-Pops","sequence":"additional","affiliation":[{"name":"Hadassah Medical Center, Jerusalem 9112102, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9056-236X","authenticated-orcid":false,"given":"Daniel","family":"Elbirt","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hadassah Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel"},{"name":"Immunology, Kaplan Medical Center, Rehovot 76100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rozalia","family":"Smolyakov","sequence":"additional","affiliation":[{"name":"Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel"},{"name":"Infectious Disease Institute, Soroka Medical Center, Beersheba 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valery","family":"Istomin","sequence":"additional","affiliation":[{"name":"Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Wax","sequence":"additional","affiliation":[{"name":"National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yael","family":"Gozlan","sequence":"additional","affiliation":[{"name":"National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3207-4226","authenticated-orcid":false,"given":"Orna","family":"Mor","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel"},{"name":"National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"ref_1","unstructured":"(2024, December 19). Migrants Being Left Behind by the HIV Response in Europe. Available online: https:\/\/www.aidsmap.com\/news\/jan-2024\/migrants-being-left-behind-hiv-response-europe."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1111\/hiv.13606","article-title":"Barriers to HIV testing and possible interventions to improve access to HIV healthcare among migrants, with a focus on migrant women: Results from a European survey","volume":"25","author":"Krankowska","year":"2024","journal-title":"HIV Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Bil, J.P., Zuure, F.R., Alvarez-Del Arco, D., Prins, J.M., Brinkman, K., Leyten, E., van Sighem, A., Burns, F., and Prins, M. (2019). Disparities in access to and use of HIV-related health services in the Netherlands by migrant status and sexual orientation: A cross-sectional study among people recently diagnosed with HIV infection. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4477-2"},{"key":"ref_4","unstructured":"European Union Agency for Fundamental Rights (2011). Migrants in an Irregular Situation: Access to Health Care in 10 European Union Member States, European Union Agency for Fundamental Rights."},{"key":"ref_5","unstructured":"ECDC (2023). HIV and Migrants. Monitoring the Implementation of the Dublin Declaration on Partnership to Fight HIV\/AIDS in Europe and Central Asia: 2022 Progress Report, European Centre for Disease Prevention and Control."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1093\/cid\/ciu018","article-title":"Antiretroviral therapy for the prevention of HIV transmission: What will it take?","volume":"58","author":"McNairy","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Song, A., Liu, X., Huang, X., Meyers, K., Oh, D.-Y., Hou, J., Xia, W., Su, B., Wang, N., and Lu, X. (2018). From CD4-Based Initiation to Treating All HIV-Infected Adults Immediately: An Evidence-Based Meta-analysis. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.00212"},{"key":"ref_8","unstructured":"Central Bureau of Statistics (2023). Population of Israel on the Eve of 2024."},{"key":"ref_9","unstructured":"Population & Immigration Authority (2024). Statistics of Foreigners in Israel-2023 Summary."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1080\/09540121.2021.1883516","article-title":"Drop-out of medical follow-up among people living with HIV in Tel-Aviv area","volume":"34","author":"Chemtob","year":"2022","journal-title":"AIDS Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s13584-019-0350-4","article-title":"Ensuring HIV care to undocumented migrants in Israel: A public-private partnership case study","volume":"8","author":"Chemtob","year":"2019","journal-title":"Isr. J. Health Policy Res."},{"key":"ref_12","first-page":"1","article-title":"Revised surveillance case definition for HIV infection-United States, 2014","volume":"63","author":"Selik","year":"2014","journal-title":"MMWR Recomm Rep"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3458","DOI":"10.1128\/JCM.01806-15","article-title":"Evaluation of the RealTime HIV-1, Xpert HIV-1, and Aptima HIV-1 Quant Dx Assays in Comparison to the NucliSens EasyQ HIV-1 v2.0 Assay for Quantification of HIV-1 Viral Load","volume":"53","author":"Mor","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_14","unstructured":"(2025, November 24). European AIDS Clinical Society. Available online: https:\/\/eacs.sanfordguide.com\/en\/eacs-hiv\/art\/eacs-virological-failure."},{"key":"ref_15","unstructured":"(2024, August 09). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV, Available online: https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/hiv-clinical-guidelines-adult-and-adolescent-arv\/virologic-failure-and-antiretroviral."},{"key":"ref_16","first-page":"24S","article-title":"Single-Tablet Regimens in the Treatment of HIV-1 Infection","volume":"33","author":"Cutrell","year":"2016","journal-title":"Fed. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"21846","DOI":"10.7448\/IAS.20.1.21846","article-title":"Comparison between next-generation and Sanger-based sequencing for the detection of transmitted drug-resistance mutations among recently infected HIV-1 patients in Israel, 2000\u20132014","volume":"20","author":"Moscona","year":"2017","journal-title":"J. Int. AIDS Soc."},{"key":"ref_18","unstructured":"(2024, August 09). HIVDB HIV Drug Resistance Database. Available online: https:\/\/hivdb.stanford.edu\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000331998","article-title":"The HIVdb system for HIV-1 genotypic resistance interpretation","volume":"55","author":"Tang","year":"2012","journal-title":"Intervirology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3276","DOI":"10.1093\/bioinformatics\/btu531","article-title":"AliView: A fast and lightweight alignment viewer and editor for large datasets","volume":"30","author":"Larsson","year":"2014","journal-title":"Bioinformatics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1093\/molbev\/msy096","article-title":"MEGA X: Molecular evolutionary genetics analysis across computing platforms","volume":"35","author":"Kumar","year":"2018","journal-title":"Mol. Biol. Evol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1093\/molbev\/msn083","article-title":"jModelTest: Phylogenetic model averaging","volume":"25","author":"Posada","year":"2008","journal-title":"Mol. Biol. Evol."},{"key":"ref_23","first-page":"1","article-title":"Estimation of extended mixed models using latent classes and latent processes: The R. package lcmm","volume":"78","author":"Philipps","year":"2017","journal-title":"J. Stat. Softw."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zeitlmann, N., Gunsenheimer-Bartmeyer, B., Santos-H\u00f6vener, C., Kollan, C., An der Heiden, M., and ClinSurv Study Group (2016). CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care-a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999\u20132013. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-2070-5"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1086\/431484","article-title":"Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells\/microL in HIV type 1-infected individuals receiving potent antiretroviral therapy","volume":"41","author":"Kaufmann","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wagner, T., Levy, I., Elbirt, D., Shahar, E., Olshtain-Pops, K., Elinav, H., Chowers, M., Istomin, V., Riesenberg, K., and Geva, D. (2023). Factors Associated with Virological Failure in First-Line Antiretroviral Therapy in Patients Diagnosed with HIV-1 between 2010 and 2018 in Israel. Viruses, 15.","DOI":"10.3390\/v15122439"},{"key":"ref_27","unstructured":"(2024, December 19). Ministry of Health Price List, Available online: https:\/\/www.gov.il\/he\/departments\/dynamiccollectors\/moh-price-list?skip=0."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wagner, T., Zuckerman, N.S., Halperin, T., Chemtob, D., Levy, I., Elbirt, D., Shachar, E., Olshtain-Pops, K., Elinav, H., and Chowers, M. (2021). Epidemiology and Transmitted HIV-1 Drug Resistance among Treatment-Na\u00efve Individuals in Israel, 2010\u20132018. Viruses, 14.","DOI":"10.3390\/v14010071"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S2055-6640(20)30347-2","article-title":"HIV drug resistance in sub-Saharan Africa: Public health questions and the potential role of real-world data and mathematical modelling","volume":"4","author":"Lessells","year":"2018","journal-title":"J. Virus Erad."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/QAI.0000000000003027","article-title":"High Levels of Pretreatment HIV-1 Drug Resistance Mutations Among South African Women Who Acquired HIV During a Prospective Study","volume":"91","author":"Beesham","year":"2022","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e733","DOI":"10.1016\/S2352-3018(23)00228-X","article-title":"HIV-1 drug resistance in people on dolutegravir-based antiretroviral therapy: A collaborative cohort analysis","volume":"10","author":"Loosli","year":"2023","journal-title":"Lancet HIV"},{"key":"ref_32","unstructured":"Weinreb, A. (2025, November 24). Israel\u2019s Demography 2023: Declining Fertility, Migration, and Mortality. Taub Center For Social Policy Studies in Israel. Jerusalem, December 2023. Available online: https:\/\/www.taubcenter.org.il\/wp-content\/uploads\/2024\/01\/Demography-ENG-2023-2.pdf."},{"key":"ref_33","unstructured":"(2024, December 19). Migration Data Relevant for the COVID-19 Pandemic. Available online: https:\/\/www.migrationdataportal.org\/themes\/migration-data-relevant-covid-19-pandemic#key-migration-trends."},{"key":"ref_34","unstructured":"ECDC (2023). HIV\/AIDS Surveillance in Europe 2023, European Centre for Disease Prevention and Control."},{"key":"ref_35","unstructured":"Ministry of Health (2024, December 19). An Updated Protocol of HIV Early Detection in Pregnant Women, Available online: https:\/\/www.gov.il\/en\/pages\/06092022-02."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Grossman, Z., Avidor, B., Mor, Z., Chowers, M., Levy, I., Shahar, E., Riesenberg, K., Sthoeger, Z., Maayan, S., and Shao, W. (2015). A Population-Structured HIV Epidemic in Israel: Roles of Risk and Ethnicity. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135061"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1097\/QAD.0000000000002883","article-title":"Exploring predictors of HIV-1 virologic failure to long-acting cabotegravir and rilpivirine: A multivariable analysis","volume":"35","author":"Cutrell","year":"2021","journal-title":"AIDS"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12977-018-0420-7","article-title":"Efficacies of Cabotegravir and Bictegravir against drug-resistant HIV-1 integrase mutants","volume":"15","author":"Smith","year":"2018","journal-title":"Retrovirology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1111\/hiv.70007","article-title":"HIV in Latin American migrants in the UK: A neglected population in the 95-95-95 targets","volume":"26","author":"Elkheir","year":"2025","journal-title":"HIV Med."},{"key":"ref_40","unstructured":"Ministry of Health (2024, December 19). Get Tested for HIV, Available online: https:\/\/www.gov.il\/en\/service\/hiv-testing-centers."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e876","DOI":"10.1016\/S2468-2667(22)00174-8","article-title":"Prevention and treatment of infectious diseases in migrants in Europe in the era of universal health coverage","volume":"7","author":"Baggaley","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref_42","unstructured":"European Centre for Disease Prevention and Control (2019). HIV and Migrants. Monitoring Implementation of the Dublin Declaration on Partnership to Fight HIV\/AIDS in Europe and Central Asia: 2018 Progress Report, ECDC."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Ullah, A.A. (2025). Displacement and disease: HIV risks and healthcare gaps among refugee populations. Venereology, 4.","DOI":"10.3390\/venereology4020007"},{"key":"ref_44","unstructured":"(2021). 2021 Observatory Report. Unheard, Unseen, and Untreated: Health Inequalities in Europe Today, M\u00e9decins du Monde. Available online: https:\/\/www.doctorsoftheworld.org.uk\/wp-content\/uploads\/2022\/03\/2021-Observatory-Report.pdf."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e428","DOI":"10.1016\/S2352-3018(22)00032-7","article-title":"HIV among migrants in precarious circumstances in the EU and European Economic Area","volume":"9","author":"Cosaert","year":"2022","journal-title":"Lancet HIV"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1566\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:43:38Z","timestamp":1764679418000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,29]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["v17121566"],"URL":"https:\/\/doi.org\/10.3390\/v17121566","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,29]]}}}