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.
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.
Below: Time to antiretroviral therapy (ART) initiation among First Nations patients compared with patients of other ethnicities
- 1Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan;
- 2School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan;
- 3Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan.
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