Anita C Benoit1,2, Jaime Younger2,3, Kerrigan Beaver2, Randy Jackson2,4, Mona Loutfy1,2,5,6, Renée Masching2,7, Tony Nobis2,8, Earl Nowgesic2,9, Doe O'Brien-Teengs2,10, Wanda Whitebird2,8, Art Zoccole2,11, Mark Hull2,12,13, Denise Jaworsky2,13, Anita Rachlis14, Sean Rourke15,16,17, Ann N Burchell9,18,19, Curtis Cooper20, Robert Hogg2,12,21, Marina B Klein22,23, Nima Machouf24,25, Julio Montaner12,13, Chris Tsoukas26, Janet Raboud2,3,9. 1. Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. 2. Building Bridges Team, Toronto, ON & Vancouver, BC, Canada. 3. Toronto General Research Institute, University Health Network, Toronto, ON, Canada. 4. McMaster University, Hamilton, ON, Canada. 5. Maple Leaf Medical Clinic, Toronto, ON, Canada. 6. Department of Medicine, University of Toronto, Toronto, ON, Canada. 7. Canadian Aboriginal AIDS Network, Dartmouth, NS, Canada. 8. Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON, Canada. 9. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 10. Lakehead University, Thunder Bay, ON, Canada. 11. 2-Spirited People of the 1st Nations, Toronto, ON, Canada. 12. British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. 13. Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 14. Sunnybrook Research Institute, Toronto, ON, Canada. 15. Ontario HIV Treatment Network, Toronto, ON, Canada. 16. Department of Psychiatry, University of Toronto, ON, Canada. 17. Department of Psychiatry, St Michael's Hospital, Toronto, ON, Canada. 18. Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada. 19. Centre for Urban Health Solutions, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada. 20. Ottawa Hospital Research Institute, Ottawa, ON, Canada. 21. Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada. 22. Department of Medicine, McGill University Health Centre Research Institute, Montréal, QC, Canada. 23. CIHR Canadian HIV Trials Network, Vancouver, BC, Canada. 24. Clinique Médicale L'Actuel, Montréal, QC, Canada. 25. Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. 26. Experimental Medicine, McGill University, Montréal, QC, Canada.
Abstract
BACKGROUND: This study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART). METHODS: Data were from the Canadian Observational Cohort collaboration; eight studies of treatment-naive persons with HIV initiating cART after 1/1/2000. Fine and Gray models were used to estimate the effect of ethnicity on time to virological suppression (two consecutive viral loads [VLs] <50 copies/ml at least 3 months apart) after adjusting for the competing risk of death and time until virological rebound (two consecutive VLs >200 copies/ml at least 3 months apart) following suppression. RESULTS: Among 7,080 participants were 497 Indigenous persons of whom 413 (83%) were from British Columbia. The cumulative incidence of suppression 1 year after cART initiation was 54% for Indigenous persons, 77% for Caucasian and 80% for African, Caribbean or Black (ACB) persons. The cumulative incidence of rebound 1 year after suppression was 13% for Indigenous persons, 6% for Caucasian and 7% for ACB persons. Indigenous persons were less likely to achieve suppression than Caucasian participants (aHR=0.58, 95% CI 0.50, 0.68), but not more likely to experience rebound (aHR=1.03, 95% CI 0.84, 1.27) after adjusting for age, gender, injection drug use, men having sex with men status, province of residence, baseline VL and CD4+ T-cell count, antiretroviral class and year of cART initiation. CONCLUSIONS: Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.
BACKGROUND: This study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART). METHODS: Data were from the Canadian Observational Cohort collaboration; eight studies of treatment-naive persons with HIV initiating cART after 1/1/2000. Fine and Gray models were used to estimate the effect of ethnicity on time to virological suppression (two consecutive viral loads [VLs] <50 copies/ml at least 3 months apart) after adjusting for the competing risk of death and time until virological rebound (two consecutive VLs >200 copies/ml at least 3 months apart) following suppression. RESULTS: Among 7,080 participants were 497 Indigenous persons of whom 413 (83%) were from British Columbia. The cumulative incidence of suppression 1 year after cART initiation was 54% for Indigenous persons, 77% for Caucasian and 80% for African, Caribbean or Black (ACB) persons. The cumulative incidence of rebound 1 year after suppression was 13% for Indigenous persons, 6% for Caucasian and 7% for ACBpersons. Indigenous persons were less likely to achieve suppression than Caucasian participants (aHR=0.58, 95% CI 0.50, 0.68), but not more likely to experience rebound (aHR=1.03, 95% CI 0.84, 1.27) after adjusting for age, gender, injection drug use, men having sex with men status, province of residence, baseline VL and CD4+ T-cell count, antiretroviral class and year of cART initiation. CONCLUSIONS: Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.