Determinants of loss to care and risk of clinical progression in PLWH who are re-engaged in care after a temporary loss

Cristina Mussini,Andrea Antinori,Alessandro Cozzi-Lepri,Sergio Lo Caputo,Enrico Girardi,Miriam Lichtner,Giulia Marchetti,Giuseppe Lapadula,Giovanni Guaraldi,Alessia Mammone,Antonella D’Arminio Monforte,Patrizia Lorenzini

doi:10.1038/s41598-021-88367-5

Abstract

The risk of developing AIDS is elevated not only among those with a late HIV diagnosis but also among those lost to care (LTC). The aims were to address the risk of becoming LTC and of clinical progression in LTC patients who re-enter care. Patients were defined as LTC if they had no visit for ≥ 18 months. Of these, persons with subsequent visits were defined as re-engaged in care (RIC). Factors associated with becoming LTC and RIC were investigated. The risk of disease progression was estimated by comparing RIC with patients continuously followed. Over 11,285 individuals included, 3962 became LTC, and of these, 1062 were RIC. Older age, presentation with AIDS and with higher HIV-RNA were associated with a reduced risk of LTC. In contrast, lower education level, irregular job, being an immigrant and injecting-drug user were associated with an increased LTC probability. Moreover, RIC with HIV-RNA > 200 copies/mL at the re-entry had a higher risk of clinical progression, while those with HIV-RNA ≤ 200 copies/mL had a higher risk of only non-AIDS progression. Patients re-entering care after being LTC appeared to be at higher risk of clinical progression than those continuously in care. Active strategies for re-engagement in care should be promoted.

Highlights

The risk of developing AIDS is elevated among those with a late HIV diagnosis and among those lost to care (LTC)
Out of the 11,285 included patients, 3962 (35%) became LTC during follow-up, including 1062 (26.8%) participants who became re-engaged in care (RIC) by re-entering the cohort after a gap in care and 2900 (73.2%) who remained lost to care at the time of this analysis (Table 1b,c)
RIC were more frequently female, Italian and employed, they showed a higher proportion of PWID and of HCV co-infected, they showed better virological and immunological parameters at enrolment than LTC patients not returning to the care

Summary

Introduction

The risk of developing AIDS is elevated among those with a late HIV diagnosis and among those lost to care (LTC). The Joint United Nations Program on HIV/AIDS launched an agenda to achieve the elimination of AIDS, introducing the “90–90–90 targets”, the so-called treatment cascade This public health campaign aims to achieve three ambitious goals by 2020: HIV diagnosis in 90% of all PLWH, the provision of antiretroviral therapy (ART) to 90% of the diagnosed individuals, and the achievement of viral suppression in 90% of the treated patients. In addition to the fact that retention in care is associated with improved HIV disease-specific outcomes, it is the step in the HIV care continuum in which the largest proportion of dropouts is o bserved[6] These data suggest that progression to advanced HIV disease could be observed among those with a late diagnosis of HIV infection and among those diagnosed early in the course of the infection who are subsequently lost to care; the latter account for up to 62% of all AIDS c ases[7]. Cases and controls were matched by age, calendar year and length of Ɵme from enrolment to re-engagement in care

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