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
Résumé
OBJECTIF: Nous avons comparé la qualité de vie liée à la santé (QVLS) de patients autochtones et non autochtones atteints du VIH après le début d’une thérapie antirétrovirale hautement active (TAHA) à Edmonton (Alberta) et cherché à savoir si leur état clinique (numération des lymphocytes CD4 et charge virale) pouvait expliquer les différences observées.
MÉTHODE: En 2006–2007, des patients admissibles ayant entamé une TAHA en 1997–2005 ont rempli le questionnaire MOS-HIV, qui mesure la QVLS. À l’aide de modèles de régression linéaire multiple, nous avons comparé les cotes sommaires de santé physique (CSP) et de santé mentale (CSM) de quatre groupes: les Autochtones infectés 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 déterminer si l’état clinique pouvait expliquer les différences observées entre ces groupes, nous avons adapté un modèle en tenant compte des caractéristiques sociodémographiques (âge et sexe) et du nombre d’années depuis le début de la TAHA seulement, puis en tenant compte, en plus, de l’état clinique actuel.
RÉSULTATS: Quatre-vingt-seize patients étaient admissibles (35 % d’Autochtones, 42 % d’UDI). Compte tenu des caractéristiques sociodémographiques et du nombre d’années depuis le début 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 inférieures à celles des non-Aut./non-UDI. En tenant aussi compte de l’état 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 à présenter des CSM inférieures à celles des non-Aut./non-UDI, mais ces relations n’étaient pas significatives, et elles s’affaiblissaient après la prise en considération de l’état clinique actuel.
CONCLUSION: La QVLS physique des Aut./UDI, des Aut./non-UDI et des non-Aut./UDI était significativement inférieure à celle des non-Aut./non-UDI. Ces différences semblent s’expliquer en partie par un moins bon état clinique, surtout pour les Aut./UDI, ce qui laisse entendre que les inégalités observées dans la QVLS physique peuvent être réduites si l’on améliore l’état clinique des patients, par exemple en améliorant l’observance de la TAHA.
Mots clés: populations autochtones, thérapie antirétrovirale hautement active, toxicomanie intraveineuse, résultat thérapeutique, qualité de vie liée à la santé
Footnotes
Previous Presentations: This work was presented in part at the 18th Annual Canadian Conference on HIV/AIDS Research, Vancouver, BC, April 23–26, 2009 (published abstract: Can J Infect Dis Med Microbiol 2009;20(Suppl B):40B) and was included as a chapter in L.J. Martin’s PhD thesis.
Acknowledgements: This study was funded by the Alberta Heritage Foundation for Medical Research (AHFMR) Health Research Fund. L.J. Martin was supported by an AHFMR full-time studentship and a Canadian Institutes for Health Research Doctoral Research Award. We thank B.E. Lee from the Provincial Public Health Laboratory for providing viral load data; the NAHIVP clinic staff for helping to enrol patients and assisting with study management; J. MacDonald for administrative assistance; J. Kele<cević for interviewing patients and entering data; and J. Bietz for entering data.
Conflict of Interest: None to declare.
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