Aboriginal Status is a Prognostic Factor for Mortality among Antiretroviral Naive HIV-Positive Individuals First Initiating HAART

Background: Although the impact of Aboriginal status on HIV incidence, HIV disease progression, and accessto treatment has been investigated previously, little is known about the relationship between Aboriginal ethnicityand outcomes associated with highly active antiretroviral therapy (HAART). We undertook the present analysisto determine if Aboriginal and non-Aboriginal persons respond differently to HAART by measuring HIV plasmaviral load response, CD4 cell response and time to all-cause mortality.Methods: A population-based analysis of a cohort of antiretroviral therapy naïve HIV-positive Aboriginal menand women 18 years or older in British Columbia, Canada. Participants were antiretroviral therapy naïve, initiatedtriple combination therapy between August 1, 1996 and September 30, 1999. Participants had to complete abaseline questionnaire as well as have at least two follow-up CD4 and HIV plasma viral load measures. Theprimary endpoints were CD4 and HIV plasma viral load response and all cause mortality. Cox proportionalhazards models were used to determine the association between Aboriginal status and CD4 cell response, HIVplasma viral load response and all-cause mortality while controlling for several confounder variables.Results: A total of 622 participants met the study criteria. Aboriginal status was significantly associated with noAIDS diagnosis at baseline (p = 0.0296), having protease inhibitor in the first therapy (p = 0.0209), lower baselineHIV plasma viral load (p < 0.001), less experienced HIV physicians (P = 0.0133), history of IDU (p < 0.001), notcompleting high school (p = 0.0046), and an income of less than $10,000 per year (p = 0.0115). Cox proportionalhazards models controlling for clinical characteristics found that Aboriginal status had an increased hazard ofmortality (HR = 3.12, 95% CI: 1.77–5.48) but did not with HIV plasma viral load response (HR = 1.15, 95% CI:0.89–1.48) or CD4 cell response (HR = 0.95, 95% CI: 0.73–1.23).Conclusion: Our study demonstrates that HIV-infected Aboriginal persons accessing HAART had similar HIVtreatment response as non-Aboriginal persons but have a shorter survival. This study highlights the need forcontinued research on medical interventions and behavioural changes among HIV-infected Aboriginal and othermarginalized populations.