Antiretroviral treatment use, co-morbidities and clinical outcomes among Aboriginal participants in the Australian HIV Observational Database (AHOD).

On Behalf Of The Australian Hiv Observational Database ,David J Templeton,Hamish Mcmanus,Matthew G Law,Darren B Russell,Stephen T Wright,Chris Lawrence,Kathy Petoumenos

doi:10.1186/s12879-015-1051-4

Abstract

BackgroundThere are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians.MethodsAHOD commenced enrolment in 1999 and is a prospective cohort of HIV-positive participants attending HIV outpatient services throughout Australia, of which 20 (74 %) sites report Indigenous status. Data were collected up until March 2013 and compared between Indigenous and non-Indigenous participants. Person-year methods were used to compare death rates, rates of loss to follow-up and rates of laboratory testing during follow-up between Indigenous and non-Indigenous participants. Factors associated with time to first combination antiretroviral therapy (cART) regimen change were assessed using Kaplan Meier and Cox Proportional hazards methods.ResultsForty-two of 2197 (1.9 %) participants were Indigenous. Follow-up amongst Indigenous and non-Indigenous participants was 332 & 16270 person-years, respectively. HIV virological suppression was achieved in similar proportions of Indigenous and non-Indigenous participants 2 years after initiation of cART (81.0 % vs 76.5 %, p = 0.635). Indigenous status was not independently associated with shorter time to change from first- to second-line cART (aHR 0.95, 95 % CI 0.51-1.76, p = 0.957). Compared with non-Indigenous participants, Indigenous participants had significantly less frequent laboratory monitoring of CD4 count (rate:2.76 tests/year vs 2.97 tests/year, p = 0.025) and HIV viral load (rate:2.53 tests/year vs 2.93 tests/year, p < 0.001), while testing rates for lipids and blood glucose were almost half that of non-indigenous participants (rate:0.43/year vs 0.71 tests/year, p < 0.001). Loss to follow-up (23.8 % vs 29.8 %, p = 0.496) and death (2.4 % vs 7.1 %, p = 0.361) occurred in similar proportions of indigenous and non-Indigenous participants, respectively, although causes of death in both groups were mostly non-HIV-related.ConclusionsAs far as we are aware, these are the first data comparing clinical outcomes between Indigenous and non-Indigenous HIV-positive Australians. The forty-two Indigenous participants represent over 10 % of all Indigenous Australians ever diagnosed with HIV. Although outcomes were not significantly different, Indigenous patients had lower rates of laboratory testing for HIV and lipid/glucose parameters. Given the elevated risk of cardiovascular disease in the general Indigenous community, the additional risk factor of HIV infection warrants further focus on modifiable risk factors to maximise life expectancy in this population.

Highlights

There are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians
Compliance with HIV therapy is recognised as a key factor in disease progression and prognosis [5], and challenging in any setting, it is likely to be complicated by a number of these factors in Indigenous Australians [6]
Study participants were 2197 of 2613 (84.1 %) individuals enrolled at these 20 sites for whom Indigenous status was available

Summary

Introduction

The rate of HIV diagnoses among Australian Aboriginal and Torres Strait Islander (hereafter “Indigenous”) people over the past decade has been similar to that among non-Indigenous Australians [1] Factors such as high rates of sexually transmitted infections, social disadvantage and poor access to health services may lead to an elevated risk of HIV infection [2], as has been witnessed among Canada’s Indigenous population [3]. Indigenous people have poorer overall health outcomes and poor access to health services [7] which is of specific concern among those living with HIV as failure to access HIV care is an important risk factor for HIV disease progression [5] Such issues, along with other co-morbidities in this population, have the potential to considerably lower survival rates in Indigenous HIV-infected individuals [6]

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