Background: In recent years, the proportion of patients attending tertiary care HIV clinics who are recent immigrants to Canada has increased dramatically.
Methods: Among patients first seen at the Toronto Hospital Immunodeficiency Clinic (Toronto, Ontario) between January 1, 2000 and August 31, 2009, the time to death from the first positive HIV test was compared between individuals who had immigrated to Canada within 10 years of their first visit and individuals who were either Canadian-born or who had immigrated more than 10 years before their first clinic visit. In addition, for the antiretroviral-naive patients in these two groups who initiated combination antiretroviral therapy, the time to and the duration of virologic suppression were compared.
Results: In a multivariable proportional hazards (PH) model, recent immigrant status was associated with decreased mortality (HR 0.11, P=0.03) after adjusting for age, CD4 count and the risk factor for men having sex with men. In multivariable PH models, recent female immigrants achieved virologic suppression more quickly (HR 1.51, P=0.02), while male immigrants (HR 1.14, P=0.44) and female nonimmigrants (HR 0.90, P=0.61) had similar times to virologic suppression as male nonimmigrants, respectively, after adjusting for the year of and viral load at combination antiretroviral therapy initiation. When pregnant women were removed from the analysis, there were no significant differences in the rates of virologic rebound according to sex or immigration status.
Discussion: Despite the perceived barriers of newcomers to Canada, mortality was lower among recent immigrants and virologic suppression was achieved more quickly in recent female immigrants.
Background: In recent years, the proportion of patients attending tertiary care HIV clinics who are recent immigrants to Canada has increased dramatically.
Methods: Among patients first seen at the Toronto Hospital Immunodeficiency Clinic (Toronto, Ontario) between January 1, 2000 and August 31, 2009, the time to death from the first positive HIV test was compared between individuals who had immigrated to Canada within 10 years of their first visit and individuals who were either Canadian-born or who had immigrated more than 10 years before their first clinic visit. In addition, for the antiretroviral-naive patients in these two groups who initiated combination antiretroviral therapy, the time to and the duration of virologic suppression were compared.
Results: In a multivariable proportional hazards (PH) model, recent immigrant status was associated with decreased mortality (HR 0.11, P=0.03) after adjusting for age, CD4 count and the risk factor for men having sex with men. In multivariable PH models, recent female immigrants achieved virologic suppression more quickly (HR 1.51, P=0.02), while male immigrants (HR 1.14, P=0.44) and female nonimmigrants (HR 0.90, P=0.61) had similar times to virologic suppression as male nonimmigrants, respectively, after adjusting for the year of and viral load at combination antiretroviral therapy initiation. When pregnant women were removed from the analysis, there were no significant differences in the rates of virologic rebound according to sex or immigration status.
Discussion: Despite the perceived barriers of newcomers to Canada, mortality was lower among recent immigrants and virologic suppression was achieved more quickly in recent female immigrants.
Historique: Ces dernières années, la proportion de patients qui sont de récents immigrants au Canada et fréquentent des cliniques de soins tertiaires du VIH a considérablement augmenté.
Méthodologie: Chez les patients d’abord vus à la clinique d’immunodéficience du Toronto Hospital de Toronto, en Ontario, entre le 1er janvier 2000 et le 31 août 2009, les chercheurs ont comparé le délai jusqu’au décès à compter du premier test positif du VIH entre les personnes qui avaient immigré au Canada dans les dix ans suivant leur première visite clinique et les personnes qui étaient nées au Canada ou avaient immigré plus de dix ans avant leur première visite clinique. De plus, ils ont comparé le délai jusqu’à la suppression virologique et la durée de cette suppression chez les patients naïfs aux antirétroviraux de ces deux groupes qui avaient amorcé une antirétrovirothérapie polyvalente.
Résultats: Dans un modèle de hasards proportionnels (HP) multivarié, l’état des récents immigrant s’associait à une diminution de la mortalité (RR 0,11, P=0,03) après redressement selon l’âge, la numération des CD4 et le facteur de risque chez les hommes qui ont des relations sexuelles entre hommes. Dans des modèles de HP multivariés, les récentes immigrantes obtenaient une suppression virale plus rapidement (RR 1,51, P=0,02), tandis que les immigrants (RR 1,14, P=0,44) et les non-immigrantes (RR 0,90, P=0,61) présentaient un délai similaire à celui des hommes non immigrants jusqu’à la suppression virologique, respectivement, après redressement compte tenu de l’année et de la charge virale au début de l’antirétrovirothérapie polyvalente. Lorsque les femmes enceintes étaient retirées de l’analyse, on ne constatait plus de différence significative dans les taux de rebond virologique selon le sexe ou le statut d’immigration.
Exposé: Malgré les obstacles perçus pour les nouveaux arrivants au Canada, la mortalité était plus faible chez les récents immigrants, tandis qu’on parvenait à la suppression virologique plus rapidement chez les récentes immigrantes.
Keywords: HIV; Immigration; Management; Sex.