Determinants of survival for Native American adults with HIV infection.

Few if any Native American/Alaska Native (NA/AN) people have been included in highly active antiretroviral therapy (HAART) treatment trials or epidemiologic studies, leaving little data on which to be assured of the efficacy of HAART in this unique population. This study aims to evaluate the impact of HAART and review determinants of survival in a cohort of NA/AN persons receiving treatment for HIV in a real life clinical setting. A retrospective chart review of 235 HIV-infected Native Americans receiving services at an urban medical center operated by the Indian Health Service from January 1, 1981 through June 30, 2004 was conducted, providing 782.7 person-years of follow-up. The main outcome measures were time from study entry and from incident AIDS diagnosis to death. Death rates fell from 18.4 (13.3-25.4) per 100 person-years in the period prior to 1998 to 6.4 (4.6-8.8) per 100 person-years in the years 1998-2004, (RR 0.35, p < 0.0001). Factors associated with the greatest reduction in risk of death from time of study entry were current use of HAART, HR 0.13 (0.06-0.30, p < 0.001), and CD4 count >/=200 at entry, HR 0.16 (0.08-0.35, p < 0.001). Current use of HAART was the strongest predictor of survival from time of AIDS diagnosis, HR 0.11 (0.05-0.25, p < 0.001). The use of HAART therapy and CD4 count were primary predictors of survival. Earlier diagnosis and access to effective medical treatment will be key factors in reducing disparities in health brought about by HIV infection in Native American/Alaska Native communities.