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 Journal Articles uri icon

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  • BackgroundThis study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART).MethodsData 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.ResultsAmong 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.ConclusionsLower 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.


  • Benoit, Anita C
  • Younger, Jaime
  • Beaver, Kerrigan
  • Jackson, Randall
  • Loutfy, Mona
  • Masching, Renée
  • Nobis, Tony
  • Nowgesic, Earl
  • O'Brien-Teengs, Doe
  • Whitebird, Wanda
  • Zoccole, Art
  • Hull, Mark
  • Jaworsky, Denise
  • Rachlis, Anita
  • Rourke, Sean
  • Burchell, Ann N
  • Cooper, Curtis
  • Hogg, Robert
  • Klein, Marina B
  • Machouf, Nima
  • Montaner, Julio
  • Tsoukas, Chris
  • Raboud, Janet

publication date

  • May 2017

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