title: Poorer physical health-related quality of life among Aboriginals and injection drug users treated with highly active antiretroviral therapy.
abstract: OBJECTIVE
  We compared the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV patients after they started highly active antiretroviral therapy (HAART) in Edmonton, Alberta and investigated whether clinical status (CD4 cell count and viral load) might explain any observed differences.
  
  
  METHODS
  In 2006-2007, eligible patients who started HAART in 1997-2005 completed the MOS-HIV to measure HRQL. Using multiple linear regression models, we compared physical (PHS) and mental (MHS) health summary scores across four groups: Aboriginals infected with HIV via injection drug use (AB/IDUs); Aboriginal non-IDUs (AB/non-IDUs); non-Aboriginal IDUs (non-AB/IDUs); and non-Aboriginal non-IDUs (non-AB/non-IDUs). To assess whether clinical status could explain any observed group differences, we fitted a model adjusting for socio-demographics (age and sex) and years since starting HAART only and then additionally adjusted for current clinical status.
  
  
  RESULTS
  Ninety-six patients were eligible (35% Aboriginal, 42% IDU). Adjusting for socio-demographics and years since starting HAART, AB/IDUs (p=0.008), AB/non-IDUs (p=0.002), and non-AB/IDUs (p=0.002) had lower PHS scores than non-AB/non-IDUs. After additionally adjusting for clinical status, these relationships remained significant for AB/non-IDUs (p=0.027) and non-AB/IDUs (p=0.048) but not for AB/IDUs (p=0.12). AB/IDUs and non-AB/IDUs tended to have worse MHS scores than non-AB/non-IDUs, but these relationships were not statistically significant and weakened after adjusting for current clinical status.
  
  
  CONCLUSIONS
  AB/IDU, AB/non-IDUs, and non-AB/IDUs had significantly poorer physical HRQL than non-AB/non-IDUs. These differences appear to be partially explained by poorer clinical status, especially for AB/IDUs, which suggests that observed inequalities in physical HRQL may be diminished by improving patients' clinical status; for example, through improved adherence to HAART.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB. leah.martin@ualberta.ca
authors.forename: Leah J
authors.initials: LJ
authors.lastname: Martin
authors.forename: Stan
authors.initials: S
authors.lastname: Houston
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: T Cameron
authors.initials: TC
authors.lastname: Wild
authors.forename: L Duncan
authors.initials: LD
authors.lastname: Saunders
mesh_terms: D000328:Adult; D044467:American Indian or Alaska Native / Q000706:statistics & numerical data*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D015331:Cohort Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D015819:Substance Abuse, Intravenous; D016896:Treatment Outcome; D019562:Viral Load / Q000706:statistics & numerical data
keywords: Aboriginal populations; antiretroviral therapy; health-related quality of life; highly active; intravenous drug users; treatment outcomes