title: A comparison of virological suppression and rebound between Indigenous and non-Indigenous persons initiating combination antiretroviral therapy in a multisite cohort of individuals living with HIV in Canada.
abstract: This study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART).
  
  
  
  Data were from the Canadian Observational Cohort collaboration; eight studies of treatment-naive persons with HIV initiating cART after 1/1/2000. Fine and Gray models were used to estimate the effect of ethnicity on time to virological suppression (two consecutive viral loads [VLs] <50 copies/ml at least 3 months apart) after adjusting for the competing risk of death and time until virological rebound (two consecutive VLs >200 copies/ml at least 3 months apart) following suppression.
  
  
  
  Among 7,080 participants were 497 Indigenous persons of whom 413 (83%) were from British Columbia. The cumulative incidence of suppression 1 year after cART initiation was 54% for Indigenous persons, 77% for Caucasian and 80% for African, Caribbean or Black (ACB) persons. The cumulative incidence of rebound 1 year after suppression was 13% for Indigenous persons, 6% for Caucasian and 7% for ACB persons. Indigenous persons were less likely to achieve suppression than Caucasian participants (aHR=0.58, 95% CI 0.50, 0.68), but not more likely to experience rebound (aHR=1.03, 95% CI 0.84, 1.27) after adjusting for age, gender, injection drug use, men having sex with men status, province of residence, baseline VL and CD4+T-cell count, antiretroviral class and year of cART initiation.
  
  
  
  Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.|Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.
authors.forename: Anita C
authors.initials: AC
authors.lastname: Benoit
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Jaime
authors.initials: J
authors.lastname: Younger
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.
authors.forename: Kerrigan
authors.initials: K
authors.lastname: Beaver
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|McMaster University, Hamilton, ON, Canada.
authors.forename: Randy
authors.initials: R
authors.lastname: Jackson
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.|Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Maple Leaf Medical Clinic, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Loutfy
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Canadian Aboriginal AIDS Network, Dartmouth, NS, Canada.
authors.forename: Renée
authors.initials: R
authors.lastname: Masching
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON, Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Nobis
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Earl
authors.initials: E
authors.lastname: Nowgesic
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Lakehead University, Thunder Bay, ON, Canada.
authors.forename: Doe
authors.initials: D
authors.lastname: O'Brien-Teengs
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON, Canada.
authors.forename: Wanda
authors.initials: W
authors.lastname: Whitebird
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|2-Spirited People of the 1st Nations, Toronto, ON, Canada.
authors.forename: Art
authors.initials: A
authors.lastname: Zoccole
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Hull
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Jaworsky
authors.affiliation: Sunnybrook Research Institute, Toronto, ON, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.affiliation: Ontario HIV Treatment Network, Toronto, ON, Canada.|Department of Psychiatry, University of Toronto, ON, Canada.|Department of Psychiatry, St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Rourke
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.|Centre for Urban Health Solutions, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Burchell
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Hogg
authors.affiliation: Department of Medicine, McGill University Health Centre Research Institute, Montréal, QC, Canada.|CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.affiliation: Clinique Médicale L'Actuel, Montréal, QC, Canada.|Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
authors.forename: Nima
authors.initials: N
authors.lastname: Machouf
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: Experimental Medicine, McGill University, Montréal, QC, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Tsoukas
authors.affiliation: Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.|Toronto General Research Institute, University Health Network, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People; D018791:CD4 Lymphocyte Count; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000254:growth & development; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology* / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D012008:Recurrence; D015819:Substance Abuse, Intravenous; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects*; D044465:White People
chemical_list: D019380:Anti-HIV Agents