title: Antiretroviral treatment outcomes among foreign-born and Aboriginal peoples living with HIV/AIDS in northern Alberta.
abstract: OBJECTIVE
  The HIV/AIDS epidemic disproportionately involves socially vulnerable populations. Since 2001, the proportion of foreign-born patients served by the Northern Alberta HIV Program has increased. Our study aimed to evaluate antiretroviral therapy (ART) outcomes among HIV-infected foreign-born patients in northern Alberta, Canada, prescribed once-daily ART.
  
  
  METHODS
  We utilized a two-part retrospective cohort study to compare ART outcomes of foreign-born and Canadian-born Aboriginal patients compared to Canadian-born non-Aboriginal patients. Part 1 utilized logistic regression to compare the odds of experiencing initial virological suppression of foreign-born (40%) and Canadian-born Aboriginal patients (27%) compared with Canadian-born non-Aboriginal patients (33%). Part 2 used survival analysis to compare the rate of ART failure by country of origin among patients who achieved initial virological suppression in Part 1.
  
  
  RESULTS
  Our study sample included 322 treatment-naïve patients (122 foreign-born). For Part 1, 261 patients achieved initial virological suppression within six months of initiating ART. After controlling for age, treatment regimen, HIV risk exposure, and calendar year compared to Canadian-born non-Aboriginal patients, the odds of achieving initial virological suppression were significantly lower for Canadian-born Aboriginal patients (OR=0.44, 95% CI: 0.20-0.96); and similar for foreign-born patients (OR=0.76, 95% CI: 0.33-1.73). Part 2 included 261 patients who were followed for 635.1 person-years. Adjusting for age, sex, baseline CD4 cell count, and drug regimen, compared to Canadian-born non-Aboriginal patients, Canadian-born Aboriginal and foreign-born patients had similar rates of virological failure after achieving initial virological suppression (HR=1.54, 95% CI: 0.38-6.18; HR=0.49, 95% CI: 0.11-2.20, respectively).
  
  
  CONCLUSIONS
  Our study indicated that ART outcomes among Alberta-based foreign-born patients are similar to those among Canadian-born non-Aboriginal patients. Our results, however, suggested that Canadian-born Aboriginal patients had poorer treatment outcomes compared to Canadian-born non-Aboriginal patients. It is imperative, therefore, that clinicians, researchers and community members better understand reasons for poor ART outcomes among Canadian-born Aboriginal patients in northern Alberta.
authors.affiliation: University of Alberta. mejohnst@ualberta.ca.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Lefebvre
authors.forename: Christine A
authors.initials: CA
authors.lastname: Hughes
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: L Duncan
authors.initials: LD
authors.lastname: Saunders
authors.forename: Stan
authors.initials: S
authors.lastname: Houston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000416:Alberta; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: Antiretroviral therapy; Canada; HIV-1; emigrants and immigrants; treatment outcomes