Abstract
The aim of our study was to identify HIV-positive patients at risk of medical care interruption (MCI) in a provincial city of a high-income country. We estimated the incidence rate of MCI in 989 individuals followed in an HIV clinic in Caen University Hospital, Normandy, France, between January 2010 and May 2016. We enrolled patients over 18 years old who were seen at the clinic at least twice after HIV diagnosis. Patients were considered to be in MCI if they did not attend care in or outside the clinic for at least 18 months, regardless of whether or not they came back after interruption. We investigated sociodemographic, clinical and immunovirological characteristics at HIV diagnosis and during follow-up through a Cox model analysis. The incidence rate of MCI was estimated to be 3.0 per 100 persons-years (95% confidence interval [CI] = 2.6-3.5). The independent risk factors for MCI were a linkage to care >6 months after HIV diagnosis (hazard ratio [HR] = 1.14; 95% CI = 1.08-1.21), a hepatitis C coinfection (HR = 1.76; 95% CI = 1.07-2.88), being born in Sub-Saharan Africa (HR = 2.18; 95% CI = 1.42-3.34 vs. in France) and not having a mailing address reported in the file (HR = 1.73; 95% CI = 1.07-2.80). During follow-up, the risk of MCI decreased when the patient was older (HR = 0.28; 95% CI = 0.15-0.51 when >45 vs. ≤ 30 years old) and increased when the patient was not on antiretroviral therapy (HR = 2.78; 95% CI = 1.66-4.63). Our findings show that it is important to link HIV-positive individuals to care quickly after diagnosis and initiate antiretroviral therapy as soon as possible to retain them in care.
Highlights
The UNAIDS goals for 2020 were that 90% of all people living with HIV (PLWH) know their HIV status, 90% of all people with diagnosed HIV infection receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART have viral suppression [1]
The independent risk factors for medical care interruption (MCI) were a linkage to care >6 months after HIV diagnosis, a hepatitis C coinfection (HR = 1.76; 95% confidence intervals (CIs) = 1.07–2.88), being born in Sub-Saharan Africa (HR = 2.18; 95% CI = 1.42–3.34 vs. in France) and not having a mailing address reported in the file (HR = 1.73; 95% CI = 1.07–2.80)
During follow-up, the risk of MCI decreased when the patient was older (HR = 0.28; 95% CI = 0.15–0.51 when >45 vs. 30 years old) and increased when the patient was not on antiretroviral therapy (HR = 2.78; 95% CI = 1.66–4.63)
Summary
The UNAIDS goals for 2020 were that 90% of all people living with HIV (PLWH) know their HIV status, 90% of all people with diagnosed HIV infection receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART have viral suppression [1]. Continuing engagement in care was the cornerstone of achieving 90% of viral suppression in treated PLWH by 2020 [2,3,4]. A regular medical follow-up is crucial to monitor the physical and mental condition of PLWH, to maintain ART adherence, and to prevent HIV transmission [5,6,7]. Improving retention in care of PLWH is a major public health issue with individual and societal outcomes. ART is effective and enables CD4 levels to increase enough to achieve a life expectancy for PLWH similar to the general population [8, 9]. That HIV has become a chronic disease with lifelong treatment, the challenge is to maintain, enhance, and facilitate retention of HIV-positive patients in the healthcare system
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