Living conditions, quality of life, adherence and treatment outcome in Greenlandic HIV patients.
OBJECTIVE
Despite a high level of sexually transmitted infections, HIV incidence has remained quite stable in Greenland with 5-6 new cases per year (approximately 10 per 100,000). However, disease control is suboptimal and mortality is relatively high. The aim of the present study was to determine associations between adherence to treatment and treatment outcome, living conditions and quality of life among HIV patients in Greenland.


METHODS
Cross-sectional questionnaire-based cohort study of HIV patients in Greenland during 2008-2009. Data regarding treatment, viral load, CD4 count, etc. were obtained from a central HIV-database.


RESULTS
Forty-six persons, 17 women and 29 men, of the 60 registered HIV-positive patients (77%) were included. Eighty percent were heterosexually infected and 17% by men having sex with men (MSM) activity. Median age at the time of diagnosis was 48 years (range 20-63). Eighty-nine percent received highly active antiretroviral therapy (HAART). Sixty-seven percent were adherent as defined by a combination of adherence to appointments and to treatment. Ninety-seven percent of adherent and 17% non-adherent patients on HAART had HIV-RNA less than 200 copies per ml (RR=24.2, p<0.0001). Poor adherence was associated with younger age (<50 years) (adjusted RR=7.95, p=0.005) and living in remote areas with no direct contact with skilled personnel (adjusted RR=6.75, p=0.01). Unsafe sex was also more frequent among non-adherent patients (RR=4.12, p=0.026), but due to few answers this topic was not included in the multivariate model.


CONCLUSIONS
The HIV population in Greenland is peculiar since most patients are heterosexually infected and middle-aged at diagnosis. A relatively poor adherence and consequently inferior treatment outcome is related to young age and living in remote areas.
Medical Department, Queen Ingrid's Hospital, Nuuk, Greenland. kala@peqqik.gl
Karin
K
Ladefoged
Mikael
M
Andersson
Anders
A
Koch
Thomas
T
Rendal
Millie
M
Rydbacken
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006116:Greenland; D006679:HIV Seropositivity / Q000188:drug therapy*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011788:Quality of Life; D055815:Young Adult