Research suggests mutated strains of HIV circulating in Saskatchewan are leading to faster-developing AIDS-related illnesses among Indigenous people.
Physicians in the province are seeing cases where people have advanced very quickly from being relatively healthy to having an extremely compromised immune system.
“Instead of it taking years, sometimes it just takes a month or a year and it’s much more aggressive than we would otherwise see,” said Dr. Alex Wong, an infectious disease physician with the Saskatchewan Health Authority.
The research from the BC Centre for Excellence in HIV/AIDS and Simon Fraser University was presented at the 2018 AIDS conference in Amsterdam on Thursday. It shows that the strains of HIV in Saskatchewan have high levels of immune-resistant mutations compared with ones in other areas of Canada and the United States.
“Physicians were saying there’s something going on here that isn’t right — people are getting sick very, very fast,” said Zabrina Brumme, lead author of the study and associate professor of health sciences at Simon Fraser University.
“It’s almost as if the virus is nastier.”
Saskatchewan’s HIV rates are among the highest in North America. Those in some areas in 2016 were more than 10 times the national average. Nearly 80 per cent of people with HIV in the province are Indigenous.
The researchers hypothesized that the quickly developing illnesses were linked with resistant strains that had adapted to the specific immune profile of Indigenous people.
“In Saskatchewan, like other places in the world, HIV is adapting to the host populations in which it is circulating,” Brumme said. “In Saskatchewan, the majority of HIV-affected persons are of Indigenous ancestry, so HIV as a result has adapted to these populations.”
The multi-year analysis compared more than 2,300 HIV sequences from Saskatchewan with sets from elsewhere in Canada and the United States.
Seventy different mutations were looked at, but one key mutation was found in more than 80 per cent of HIV strains in the province, compared with only about 25 per cent of HIV strains found elsewhere in North America.
More than 98 per cent of the HIV sequences collected in Saskatchewan had at least one major immune-resistant mutation. Researchers said that means the strains with similar mutations are being frequently and widely transmitted.
Jeffrey Joy, research scientist with the BC Centre for Excellence in HIV/AIDS, said while the findings are concerning, the good news is that if people get tested, treatment still works on immune-resistant strains.
He said it’s critical to expand access to HIV testing and treatment in Saskatchewan because antiretrovirals not only make a person’s symptoms diminish, but can also stop the spread of the mutated HIV strains.
“Strains that carry the mutations will slowly die out because they won’t be transmitted to other individuals,” Joy said.
The researchers said they plan to go to Saskatchewan and meet with communities and physicians to talk about the results and encourage more testing.
Wong said there are challenges around testing and treatment —health care is centralized in three urban areas and there is still a stigma about getting tested.
If a person is diagnosed, he said, treatment is a lifetime endeavour, and many people are also facing mental-health and addictions issues.
“The drugs work extremely well,” he said. “The challenge oftentimes is getting people linked to care and keeping them linked to care.”
The government of Saskatchewan announced an additional $600,000 in the 2018-19 budget for HIV medications.