Association between ethnicity and human leukocyte antigen (HLA) alleles on late presentation to care and high rates of opportunistic infections in patients with HIV

Abstract

Within Manitoba, Aboriginal people make up 15% of the province’s population, but accounted for 53% of new human immunodeficiency virus (HIV) diagnoses in 2011. For over a decade, research has linked the human leukocyte antigen (HLA) class I alleles as having both protective and harmful effects in HIV disease progression. The abundance of HLA alleles that predispose to rapid disease progression, together with the rarity of protective HLA allele types, may be a contributing factor to a more rapid disease progression amongst individuals of Aboriginal ethnicity. We completed an epidemiological study on all HIV patients new to care in the Manitoba HIV Program in 2010, looking at markers of disease severity, such as CD4 cell count, rates of opportunistic infections (OI), and HLA type. In this cohort, the Aboriginal population was overrepresented, and presented with significantly more advanced HIV infection (lower CD4 counts, higher rates of OI), compared to patients from a Caucasian background. Our data supports previously identified associations between HLA type and disease progression, and demonstrates a difference in distribution of HLA type by ethnicity. Key words: Aboriginal, disease progression, ethnicity, HLA B27, HLA B35, HLA B51, HLA B5701, human immunodeficiency virus, human leukocyte antigen, opportunistic infection.