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: AIDS incidence; AIDS mortality; CD4 cell count; HIV; low- and middle-income country; migrant.

Figure 1

Boxplot summary of participants CD4 cell count at various time points since Australian HIV Observational Database cohort enrolment. Data stratified by country of birth World Bank income groupings.

Figure 2

Number of participant HIV monitoring measurements (CD4 cell count and HIV RNA viral load) taken per year stratified by time since Australian HIV Observational Database cohort enrolment and country of birth World Bank income grouping.

Figure 3

Cumulative incidence of participants lost-to-follow-up (differences in t = 0 numbers due to no follow-up visit recorded), defined as not seen at health service for >365 days, by country of birth World Bank income grouping.

Figure 4

Cumulative incidence clinical endpoint (all-cause mortality and new AIDS illness) of participants by time since Australian HIV Observational Database cohort enrolment by country of birth World Bank income grouping.