1. Poorer physical health-related quality of life among aboriginals and injection drug users treated with highly active antiretroviral therapy
- Author
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Martin, Leah J., Houston, Stan, Yasui, Yutaka, Wild, T. Cameron, and Saunders, L. Duncan
- Subjects
Antiviral agents -- Dosage and administration ,Highly active antiretroviral therapy -- Demographic aspects ,Canadian native peoples -- Health aspects ,Indigenous peoples -- Health aspects ,Government ,Health ,Health care industry - 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. KEY WORDS: Aboriginal populations; antiretroviral therapy, highly active; intravenous drug users; treatment outcomes; health-related quality of life OBJECTIF : Nous avons compare la qualite de vie liee a la sante (QVLS) de patients autochtones et non autochtones atteints du VIH apres le debut d'une therapie antiretrovirale hautement active (TAHA) a Edmonton (Alberta) et cherche a savoir si leur etat clinique (numeration des lymphocytes CD4 et charge virale) pouvait expliquer les differences observees. METHODE : En 2006-2007, des patients admissibles ayant entame une TAHA en 1997-2005 ont rempli le questionnaire MOS-HIV, qui mesure la QVLS. A l'aide de modeles de regression lineaire multiple, nous avons compare les cotes sommaires de sante physique (CSP) et de sante mentale (CSM) de quatre groupes : les Autochtones infectes par le VIH via l'utilisation de drogues par injection (Aut./UDI); les Autochtones non-UDI (Aut./non-UDI); les non-Autochtones UDI (non-Aut./UDI); et les non-Autochtones non-UDI (non-Aut./non-UDI). Pour determiner si l'etat clinique pouvait expliquer les differences observees entre ces groupes, nous avons adapte un modele en tenant compte des caracteristiques sociodemographiques (age et sexe) et du nombre d'annees depuis le debut de la TAHA seulement, puis en tenant compte, en plus, de l'etat clinique actuel. RESULTATS : Quatre-vingt-seize patients etaient admissibles (35 % d'Autochtones, 42 % d'UDI). Compte tenu des caracteristiques sociodemographiques et du nombre d'annees depuis le debut de la TAHA, les Aut./UDI (p=0,008), les Aut./non-UDI (p=0,002) et les non-Aut./UDI (p=0,002) avaient des cotes CSP inferieures a celles des non-Aut./non-UDI. En tenant aussi compte de l'etat clinique, ces relations demeuraient significatives pour les Aut./non-UDI (p=0,027) et les non-Aut./UDI (p=0,048), mais pas pour les Aut./UDI (p=0,12). Les Aut./UDI et les non-Aut./UDI avaient tendance a presenter des CSM inferieures a celles des non-Aut./non-UDI, mais ces relations n'etaient pas significatives, et elles s'affaiblissaient apres la prise en consideration de l'etat clinique actuel. CONCLUSION : La QVLS physique des Aut./UDI, des Aut./non-UDI et des non-Aut./UDI etait significativement inferieure a celle des non-Aut./non-UDI. Ces differences semblent s'expliquer en partie par un moins bon etat clinique, surtout pour les Aut./UDI, ce qui laisse entendre que les inegalites observees dans la QVLS physique peuvent etre reduites si l'on ameliore l'etat clinique des patients, par exemple en ameliorant l'observance de la TAHA. MOTS CLES : populations autochtones; therapie antiretrovirale hautement active; toxicomanie intraveineuse; resultat therapeutique; qualite de vie liee a la sante, In Canada, Aboriginals and non-Aboriginals infected with HIV do not appear to receive equal benefit from highly active antiretroviral therapy (HAART). After starting HAART, Aboriginals have been shown to experience [...]
- Published
- 2013