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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 23 (2012), Issue 1, Pages 9-14
http://dx.doi.org/10.1155/2012/963474
Original Article

Recent Immigrants Show improved Clinical Outcomes at a Tertiary Care HIV Clinic

Janet Raboud,1,2 Sandra Blitz,2 Tony Antoniou,3,4 Mona Loutfy,5,6 and Sharon Walmsley2,6

1Dalla Lana School of Public Health, University of Toronto, Canada
2University Health Network, Canada
3Maple Leaf Medical Clinic, Canada
4St Michael’s Hospital, Canada
5Women’s College Research Institute, Women’s College Hospital, Canada
6Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Copyright © 2012 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.