Abstract
To assess the impact of clinical and social factors unique to HIV-infected adults in Saskatoon, Saskatchewan, regarding the rate of CD4(+) count change, and to identify factors associated with a risk of CD4(+) count decline. A retrospective longitudinal cohort study from medical chart reviews at two clinics was conducted in Saskatoon. Univariate and multivariate linear mixed effects models were used to assess the impact of selected factors on CD4(+) count change. Four hundred eleven HIV-infected patients were identified from January 1, 2003 to November 30, 2011. Two hundred eighteen (53%) were male, mean (± SD) age was 35.6 ±10.1 years, 257 (70.8%) were First Nations or Métis, 312 (80.2%) were hepatitis C virus (HCV) coinfected and 300 (73.3%) had a history of injection drug use (IDU). In univariate models, age, ethnicity, HCV, IDU, antiretroviral therapy and social assistance were significant. Using ethnicity, HCV and IDU, three multivariate models (models 1, 2, 3) were built due to high correlation. First Nations or Métis ethnicity, HCV coinfection and a history of IDU were associated with significantly lower CD4(+) counts in multivariate models. Older age and social assistance were associated with significantly lower CD4(+) counts in models 1 and 3. Age was marginally significant in model 2 (P=0.055). Not prescribed antiretroviral therapy was associated with a significantly negative CD4(+) count slope in all multivariate models. The unique epidemiology of this HIV-infected population may be contributing to CD4(+) count change. Increased attention and resources focused on this high-risk population are needed to prevent disease progression and to improve overall health and quality of life.
Highlights
Two hundred fifty-seven (70.8%) patients self-identified as being of First Nations or Métis ethnicity
We investigated CD4+ changes over time to explore HIV disease progression to immunological AIDS
Summary The HIV-infected population of Saskatoon is characterized according to unique social and clinical factors, which may conspire to contribute to an accelerated progression to AIDS
Summary
Setting and population The present study was a retrospective longitudinal cohort anaylsis of HIV-infected patients followed at two clinics in Saskatoon, specializing in the care of this population: the Positive Living Program at Royal University Hospital and the Westside Community Clinic (WSCC).Data collection Data were abstracted from patient charts. Inclusion criteria included a new HIV diagnosis of patients ≥18 years of age between January 1, 2003 and November 30, 2011. Patient data abstracted from medical charts included demographics, social history, clinical variables, laboratory data and ART. Data analyses Patient characteristics at HIV diagnosis (baseline) and during followup (time dependent) were summarized using descriptive statistics. Before fitting mixed effect models on CD4+ count outcome, the CD4+ count of an individual was summarized in three-month intervals for the first three years and in six-month intervals for the remainder of the study time. If a subject underwent more than one measurement in a given interval, the mean was used This interval was selected because this is the standard clinical follow-up timeline for patients observed in the two clinics. All analyses were performed using SAS version 9.2 (SAS Institute, USA)
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