1. A Comparison of Virological Suppression and Rebound between Indigenous and Non-Indigenous Persons Initiating Combination Antiretroviral Therapy in a Multisite Cohort of Individuals Living with HIV in Canada
- Author
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Chris Tsoukas, Randy Jackson, Robert S. Hogg, Kerrigan Beaver, Anita C Benoit, Mark Hull, Sean B. Rourke, Doe O'Brien-Teengs, Julio S. G. Montaner, Jaime Younger, Nima Machouf, Denise Jaworsky, Wanda Whitebird, Mona Loutfy, Anita Rachlis, Janet Raboud, Earl Nowgesic, Ann N. Burchell, Tony Nobis, Curtis Cooper, Renée Masching, Marina B. Klein, Art Zoccole, and Building Bridges
- Subjects
Adult ,Male ,Canada ,medicine.medical_specialty ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,Black People ,HIV Infections ,medicine.disease_cause ,White People ,Indigenous ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Population Groups ,Recurrence ,Antiretroviral Therapy, Highly Active ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Homosexuality, Male ,Substance Abuse, Intravenous ,Pharmacology ,030505 public health ,business.industry ,HIV ,Middle Aged ,Viral Load ,Antiretroviral therapy ,CD4 Lymphocyte Count ,Treatment Outcome ,Infectious Diseases ,Cohort ,Immunology ,Female ,0305 other medical science ,business - Abstract
BackgroundThis study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART).MethodsData 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] 200 copies/ml at least 3 months apart) following suppression.ResultsAmong 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.ConclusionsLower 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.
- Published
- 2016
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