Neighbourhood-level material deprivation and response to combination antiretroviral therapy in the Canadian Observational Cohort (CANOC): a longitudinal cohort study

CMAJ open Pub Date : 2022-01-01 DOI:10.9778/cmajo.20200249
A. McClean, J. Trigg, Monica Ye, Taylor McLinden, K. Kooij, Nicanor Bacani, Christian Hui, P. Sereda, A. Burchell, S. Walmsley, D. Kelly, N. Machouf, J. Montaner, M. Loutfy, R. Hogg
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Abstract

Background: Socioeconomic status has been associated with higher viral loads and lower CD4 cell counts among people living with HIV. The objective of this study was to evaluate the relation between neighbourhood-level material deprivation and immunologic and virologic response to combination antiretroviral therapy (ART) among people living with HIV in Canada. Methods: The Canadian Observational Cohort (CANOC) is a longitudinal cohort of people living with HIV, containing data from 2000–2016 from 5 Canadian provinces. We defined response to combination ART as positive if the CD4 cell count increased by 50 cells/mm3 (0.05 cells × 109/L) or more (CD4+) and viral load decreased to 50 copies/mL or less (VL+) within 6 months of treatment initiation. We further categorized response to therapy as concordant positive (CD4+/VL+), concordant negative (CD4−/VL−) or discordant (CD4+/VL− or CD4−/VL+). We used adjusted multinomial logistic regression to quantify the relation between neighbourhood-level material deprivation and immunologic and virologic response. Results: This study included 8274 people living with HIV, of which 1754 (21.2%) lived in the most materially deprived neighbourhoods. Most individuals (62.2%) showed a concordant positive response to combination ART. After adjustment, living in the most materially deprived neighbourhoods was associated with a CD4−/VL+ discordant response (adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06–1.62) and a concordant negative response (adjusted OR 1.45, 95% CI 1.13–1.86), using a concordant positive response as the reference. No other deprivation quartile was independently associated with a particular response. Interpretation: People living with HIV from the most materially deprived neighbourhoods had increased odds of poor immunologic or virologic response to combination ART. These results motivate further study of the specific socioeconomic factors that potentially affect response to combination ART among people living with HIV in Canada.
加拿大观察队列(CANOC)中邻居水平的物质匮乏和对联合抗逆转录病毒疗法的反应:一项纵向队列研究
背景:HIV感染者的社会经济地位与较高的病毒载量和较低的CD4细胞计数有关。本研究的目的是评估社区水平的物质剥夺与加拿大艾滋病毒感染者对联合抗逆转录病毒治疗(ART)的免疫和病毒学反应之间的关系。方法:加拿大观察队列(CANOC)是一个HIV感染者的纵向队列,包含来自加拿大5个省2000-2016年的数据。如果CD4细胞计数增加50个细胞/mm3(0.05个细胞× 109个/L)或更多(CD4+),并且病毒载量在治疗开始的6个月内下降到50拷贝/mL或更少(VL+),我们将联合抗逆转录病毒治疗的反应定义为阳性。我们进一步将治疗反应分为协调阳性(CD4+/VL+)、协调阴性(CD4−/VL−)或不协调(CD4+/VL−或CD4−/VL+)。我们使用调整后的多项逻辑回归来量化社区水平物质剥夺与免疫和病毒学反应之间的关系。结果:本研究纳入8274例HIV感染者,其中1754例(21.2%)生活在物质最贫困的社区。大多数个体(62.2%)对联合抗逆转录病毒治疗表现出一致的阳性反应。调整后,生活在物质最贫困的社区与CD4−/VL+不一致反应(调整优势比[OR] 1.31, 95%置信区间[CI] 1.06-1.62)和一致的负面反应(调整优势比[OR] 1.45, 95% CI 1.13-1.86)相关,以一致的积极反应为参考。没有其他剥夺四分位数与特定反应独立相关。解释:来自物质最贫困社区的艾滋病毒感染者对联合抗逆转录病毒治疗的免疫或病毒学反应较差的几率增加。这些结果促使进一步研究可能影响加拿大艾滋病毒感染者对联合抗逆转录病毒治疗反应的具体社会经济因素。
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