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      • HARVEST
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      Identifying determinants of HIV disease progression in Saskatoon, Saskatchewan

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      Stephanie_Conrad_MSc_Thesis_August_2011.pdf (3.144Mb)
      Date
      2011
      Author
      Konrad, Stephanie
      Type
      Thesis
      Degree Level
      Masters
      Metadata
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      Abstract
      Context & Rationale: Individuals with similar CD4 cell counts and RNA levels can vary considerably with regards to clinical progression. This variation is likely the result of a complex interplay between viral, host and environmental factors. This study aimed to characterize and identify predictors associated with disease progression to AIDS or death in Saskatoon, Saskatchewan. Methods: This is a retrospective cohort study of 343 seroprevalent HIV positive patients diagnosed from Jan 2005 to Dec 2010. Of these, 73 had an estimated seroconversion date. Data was extracted from medical charts at two clinics specialized in HIV/AIDS care. Disease progression was measured as time from HIV diagnosis (or seroconversion) to immunological AIDS and death. The Cox hazard model was used. Results: The 3-year and 5-year immunological AIDS free probability was 53% and 33%, respectively. The 3-year and 5-year survival probability was 89% and 77%, respectively. Among the seroconversion cohort, the 3-year immunological AIDS free probability was 76%. Due to multicollinearity, separate models were built for IDU, hepatitis C and ethnicity. A history of IDU (HR, 3.0; 95%CI, 1.2-7.1), hepatitis C coinfection (HR, 2.9; 95%CI, 1.2-6.9), baseline CD4 counts (HR, 0.95; 95%CI, 0.92-0.98, per ever 10 unit increase), ever on ART, and year of diagnosis were significant predictors of progression to immunological AIDS among the seroprevalent cohort. Age at diagnosis, sex and ethnicity were not. For survival, only treatment use was a significant predictor (HR, 0.34; 95%CI, 0.1-0.8). Hepatitis C coinfection was marginally significant (p=0.067), while a history of IDU, ethnicity, gender, age at diagnosis, and year of diagnosis were not. Among the seroconversion cohort, no predictors of progression to immunological AIDS were identified. Ethnicity, hepatitis C coinfection and history of IDU could not be assessed. Conclusion: Our study found that IDU, HCV coinfections, baseline CD4 counts, and ART use were significant predictors of disease progression. This highlights the need for increased testing and early detection and for targeted interventions for these particularly vulnerable populations to slow disease progression.
      Degree
      Master of Science (M.Sc.)
      Department
      Community Health and Epidemiology
      Program
      Community Health and Epidemiology
      Supervisor
      Skinner, Stuart; Lim, Hyun
      Committee
      Abonyi, Sylvia; Reeder, Bruce; Janzen, Bonnie; Keynan, Yoav
      Copyright Date
      2011
      URI
      http://hdl.handle.net/10388/etd-08282011-200006
      Subject
      HIV Disease Progression
      Survival Analysis
      Hepatitis C
      Injection Drug Use
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