Treatment and disease outcomes of migrants from low- and middle-income countries in the Australian HIV Observational Database cohort

ABSTRACT

People from culturally and linguistically diverse backgrounds, including low- and middle-income countries, account for a third of new HIV diagnoses in Australia and are a priority for HIV prevention and treatment programs. We describe the demographic and clinical characteristics of participants in the Australian HIV Observational Database (AHOD) and compare disease outcomes, progression to AIDS and treatment outcomes of those born in low- and middle-income countries, with those born in high-income countries and Australia. All participants enrolled in AHOD sites where country of birth is routinely collected were included in the study. Age, CD4 count, HIV viral load, antiretroviral therapy, hepatitis co-infection, all-cause mortality and AIDS illness were analysed. Of 2403 eligible participants, 77.3% were Australian born, 13.7% born in high-income countries and 9.0% born in middle- or low-income countries. Those born in Australia or high-income countries were more likely to be male (96%) than those from middle- or low-income countries (76%), p < .0001 and more likely to have acquired HIV via male to male sexual contact (77%; 79%) compared with those from middle- or low-income countries (50%), p < .0001. At enrolment, mean CD4 cell count was higher in Australian born (528 cells/µL) than both those born in high-income countries (468 cells/µL) and those born in middle- and low-income countries (451 cells/µL), p < .0001; whereas the mean HIV RNA level (log10 copies/mL) was similar in all three groups (4.44, 4.76 and 4.26, respectively), p = .19.There was no difference in adjusted incidence risk ratios for all-cause mortality and AIDS incidence in all three groups, p = .39. These findings reflect successful outcomes of people born in low- and middle-income countries once engaged in HIV care.

KEYWORDS:

• HIV
• migrant
• low- and middle-income country
• CD4 cell count
• AIDS mortality
• AIDS incidence

Acknowledgements

Australian HIV Observational Database contributors (asterisks indicate steering committee members in 2013) are given as follows: New South Wales: D. Ellis, General Medical Practice, Coffs Harbour; M. Bloch, S. Agrawal, T. Vincent, Holdsworth House Medical Practice, Darlinghurst; D. Allen, J.L. Little, Holden Street Clinic, Gosford; D. Smith, Lismore Sexual Health & AIDS Services, Lismore; D. Baker*, V. Ieroklis, East Sydney Doctors, Surry Hills; D.J. Templeton*, C.C. O'Connor, S. Phan, RPA Sexual Health Clinic, Camperdown; E. Jackson, K. McCallum, Blue Mountains Sexual Health and HIV Clinic, Katoomba; M. Grotowski, S. Taylor, Tamworth Sexual Health Service, Tamworth; D. Cooper, A. Carr, F. Lee, K. Hesse, St Vincent's Hospital, Darlinghurst; R. Finlayson, A. Patel, S. Gupta, Taylor Square Private Clinic, Darlinghurst; R. Varma, J. Shakeshaft, Nepean Sexual Health and HIV Clinic, Penrith; K. Brown, V. McGrath, S. Halligan, N. ArvelaIllawarra Sexual Health Service, Warrawong; L. Wray, R. Foster, H. Lu, Sydney Sexual Health Centre, Sydney; D. Couldwell, Parramatta Sexual Health Clinic; D.E. Smith*, V. Furner Albion Street Centre; Clinic 16 – Royal North Shore Hospital; S. Fernando, Dubbo Sexual Health Centre, Dubbo; J. Watson*, National Association of People living with HIV/AIDS; C. Lawrence*, National Aboriginal Community Controlled Health Organisation; B. Mulhall*, Department of Public Health and Community Medicine, University of Sydney; M. Law*, K. Petoumenos*, S. Wright*, H. McManus*, C. Bendall*, M. Boyd*, The Kirby Institute, University of NSW. Northern Territory: N. Ryder, R. Payne, Communicable Disease Centre, Royal Darwin Hospital, Darwin. Queensland: M. O'Sullivan, S. White, Gold Coast Sexual Health Clinic, Miami; D. Russell, S. Doyle-Adams, C. Cashman, Cairns Sexual Health Service, Cairns; D. Sowden, K. Taing, K. McGill, Clinic 87, Sunshine Coast-Wide Bay Health Service District, Nambour; D. Orth, D. Youds, Gladstone Road Medical Centre, Highgate Hill; M. Kelly, D. Rowling, N. Latch, Brisbane Sexual Health and HIV Service, Brisbane; B. Dickson*, CaraData. South Australia: W. Donohue, O'Brien Street General Practice, Adelaide. Victoria: R. Moore, S. Edwards, R. Woolstencroft Northside Clinic, North Fitzroy; N.J. Roth*, H. Lau, Prahran Market Clinic, South Yarra; T. Read, J. Silvers*, W. Zeng, Melbourne Sexual Health Centre, Melbourne; J. Hoy*, K. Watson*, M. Bryant, S. Price, The Alfred Hospital, Melbourne; I. Woolley, M. Giles*, T. Korman, J. Williams*, Monash Medical Centre, Clayton. Western Australia: D. Nolan, J. Robinson, Department of Clinical Immunology, Royal Perth Hospital, Perth. New Zealand: G. Mills, C. Wharry, Waikato District Hospital Hamilton; N. Raymond, K. Bargh, Wellington Hospital, Wellington.

Coding of Death Form (CoDe) reviewers are given as follows:

AHOD reviewers are given as follows: D. Sowden, J. Hoy, L. Wray, K. Morwood, T. Read, N. Roth, I. Woolley, K. Choong, C. O'Connor, M. Boyd..

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The Australian HIV Observational Database is funded as part of the Asia Pacific HIV Observational Database, a program of The Foundation for AIDS Research, amfAR, and is supported in part by a grant from the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) (Grant No. U01-AI069907) and by unconditional grants from Merck Sharp & Dohme; Gilead Sciences; Bristol-Myers Squibb; Boehringer Ingelheim; ViiV Australia; Janssen-Cilag. The Kirby Institute is affiliated with the Faculty of Medicine, University of New South Wales. Jennifer Hoy's institution receives funding for her participation in Advisory Boards for Gilead Sciences, ViiV Healthcare and Merck Sharp & Dohme. Ian Wolley has received research funds from Gilead Sciences and MSD, consulting funds from Bristol Myers Squibb and Gilead Sciences and chairing fees from Abbott and MSD. Conference support from MSD, Viiv Healthcare and Abbott. The rest of the authors declare no conflict of interest.