Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada

• Published in: Canadian journal of public health 2017-01, Vol.108 (2), p.e169-e175
• Main Authors: Benoit, Anita C., Younger, Jaime, Beaver, Kerrigan, Jackson, Randy, Loutfy, Mona, Masching, Renée, Nobis, Tony, Nowgesic, Earl, O’Brien-Teengs, Doe, Whitebird, Wanda, Zoccole, Art, Hull, Mark, Jaworsky, Denise, Benson, Elizabeth, Rachlis, Anita, Rourke, Sean B., Burchell, Ann N., Cooper, Curtis, Hogg, Robert S., Klein, Marina B., Machouf, Nima, Montaner, Julio S.G., Tsoukas, Chris, Raboud, Janet
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Age; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Canada - epidemiology; Cause of Death - trends; CD4 antigen; Cohort Studies; Collaboration; Death; Drug Therapy, Combination; Drugs; Female; Gender; Hazards; Health hazards; Health Status Disparities; Hepatitis; Hepatitis C; HIV; HIV Infections - drug therapy; HIV Infections - ethnology; HIV Infections - mortality; Human immunodeficiency virus; Humans; Indians, North American - statistics & numerical data; Indigenous peoples; Injection; Inuits - statistics & numerical data; Lymphocytes; Male; Medicine & Public Health; Men; Middle Aged; Minority & ethnic groups; Missing data; Mortality; Mortality - ethnology; Patients; Public Health; QUANTITATIVE RESEARCH; Survival; Therapy
• ISSN: 0008-4263; 1920-7476
• DOI: 10.17269/CJPH.108.5708

OBJECTIVE: Compare all-cause mortality between Indigenous participants and participants of other ethnicities living with HIV initiating combination antiretroviral therapy (cART) in an interprovincial multi-site cohort. METHODS: The Canadian Observational Cohort is a collaboration of 8 cohorts of treatment-naïve persons with HIV initiating cART after January 1, 2000. Participants were followed from the cART initiation date until death or last viral load (VL) test date on or before December 31, 2012. Cox proportional hazard models were used to estimate the effect of ethnicity on time until death after adjusting for age, gender, injection drug use, being a man who has sex with men, hepatitis C, province of origin, baseline VL and CD4 count, year of cART initiation and class of antiretroviral medication. RESULTS: The study sample consisted of 7080 participants (497 Indigenous, 2471 Caucasian, 787 African/Caribbean/Black (ACB), 629 other, and 2696 unknown ethnicity). Most Indigenous persons were from British Columbia (BC) (83%), with smaller numbers from Ontario (13%) and Québec (4%). During the study period, 714 (10%) participants died. The five-year survival probability was lower for Indigenous persons (0.77) than for Caucasian (0.94), ACB (0.98), other ethnicities (0.96) and unknown ethnicities (0.85) ( p < 0.0001). In an adjusted proportional hazard model for which missing data were imputed, Indigenous persons were more likely to die than Caucasian participants (hazard ratio = 2.69, p < 0.0001). CONCLUSION: The mortality rate for Indigenous persons was higher than for other ethnicities and is largely reflective of the BC population. Addressing treatment challenges and identifying HIV- and non-HIV-related causes for mortality among Indigenous persons is required to optimize their clinical management.