Antiretroviral treatment use, co-morbidities and clinical outcomes among Aboriginal participants in the Australian HIV Observational Database (AHOD).
BACKGROUND
There are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians.


METHODS
AHOD commenced enrolment in 1999 and is a prospective cohort of HIV-positive participants attending HIV outpatient services throughout Australia, of which 20 (74 %) sites report Indigenous status. Data were collected up until March 2013 and compared between Indigenous and non-Indigenous participants. Person-year methods were used to compare death rates, rates of loss to follow-up and rates of laboratory testing during follow-up between Indigenous and non-Indigenous participants. Factors associated with time to first combination antiretroviral therapy (cART) regimen change were assessed using Kaplan Meier and Cox Proportional hazards methods.


RESULTS
Forty-two of 2197 (1.9 %) participants were Indigenous. Follow-up amongst Indigenous and non-Indigenous participants was 332 & 16270 person-years, respectively. HIV virological suppression was achieved in similar proportions of Indigenous and non-Indigenous participants 2 years after initiation of cART (81.0 % vs 76.5 %, p = 0.635). Indigenous status was not independently associated with shorter time to change from first- to second-line cART (aHR 0.95, 95 % CI 0.51-1.76, p = 0.957). Compared with non-Indigenous participants, Indigenous participants had significantly less frequent laboratory monitoring of CD4 count (rate:2.76 tests/year vs 2.97 tests/year, p = 0.025) and HIV viral load (rate:2.53 tests/year vs 2.93 tests/year, p < 0.001), while testing rates for lipids and blood glucose were almost half that of non-indigenous participants (rate:0.43/year vs 0.71 tests/year, p < 0.001). Loss to follow-up (23.8 % vs 29.8 %, p = 0.496) and death (2.4 % vs 7.1 %, p = 0.361) occurred in similar proportions of indigenous and non-Indigenous participants, respectively, although causes of death in both groups were mostly non-HIV-related.


CONCLUSIONS
As far as we are aware, these are the first data comparing clinical outcomes between Indigenous and non-Indigenous HIV-positive Australians. The forty-two Indigenous participants represent over 10 % of all Indigenous Australians ever diagnosed with HIV. Although outcomes were not significantly different, Indigenous patients had lower rates of laboratory testing for HIV and lipid/glucose parameters. Given the elevated risk of cardiovascular disease in the general Indigenous community, the additional risk factor of HIV infection warrants further focus on modifiable risk factors to maximise life expectancy in this population.
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. david.templeton@sswahs.nsw.gov.au.|RPA Sexual Health, Sydney Local Health District, Camperdown, NSW, 2050, Australia. david.templeton@sswahs.nsw.gov.au.|Central Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia. david.templeton@sswahs.nsw.gov.au.
David J
DJ
Templeton
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. swright@kirby.unsw.edu.au.
Stephen T
ST
Wright
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. hmcmanus@kirby.unsw.edu.au.
Hamish
H
McManus
The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia. chrislawrence80@hotmail.com.
Chris
C
Lawrence
Cairns Sexual Health Service, PO Box 902, Cairns, QLD 4870, Australia. Darren.russell@health.qld.gov.au.|The University of Melbourne, VIC, Australia. Darren.russell@health.qld.gov.au.|James Cook University, Queensland, Australia. Darren.russell@health.qld.gov.au.
Darren B
DB
Russell
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. mlaw@kirby.unsw.edu.au.
Matthew G
MG
Law
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. kpetoumenos@kirby.unsw.edu.au.
Kathy
K
Petoumenos
D000328:Adult; D000553:Ambulatory Care; D023241:Antiretroviral Therapy, Highly Active; D001315:Australia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis