Affiliations 

  • 1 The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
  • 2 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 3 Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
  • 4 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 5 Taipei Veterans General Hospital, Taipei, Taiwan
  • 6 Research Institute for Tropical Medicine, Manila, Philippines
  • 7 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 8 HIV-NAT, The Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 9 Institute of Infectious Diseases, Pune, India
  • 10 Bach Mai Hospital, Hanoi, Vietnam
  • 11 Queen Elizabeth Hospital, Hong Kong, China
  • 12 National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia
  • 13 Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 14 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), The Voluntary Health Services (VHS), Chennai, India
  • 15 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 16 National Center for Global Health and Medicine, Tokyo, Japan
  • 17 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 18 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 19 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 20 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 21 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
  • 22 Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
HIV Med., 2019 Apr 12.
PMID: 30980495 DOI: 10.1111/hiv.12734

Abstract

OBJECTIVES: With earlier antiretroviral therapy (ART) initiation, time spent in HIV care is expected to increase. We aimed to investigate loss to follow-up (LTFU) in Asian patients who remained in care 5 years after ART initiation.

METHODS: Long-term LTFU was defined as LTFU occurring after 5 years on ART. LTFU was defined as (1) patients not seen in the previous 12 months; and (2) patients not seen in the previous 6 months. Factors associated with LTFU were analysed using competing risk regression.

RESULTS: Under the 12-month definition, the LTFU rate was 2.0 per 100 person-years (PY) [95% confidence interval (CI) 1.8-2.2 among 4889 patients included in the study. LTFU was associated with age > 50 years [sub-hazard ratio (SHR) 1.64; 95% CI 1.17-2.31] compared with 31-40 years, viral load ≥ 1000 copies/mL (SHR 1.86; 95% CI 1.16-2.97) compared with viral load < 1000 copies/mL, and hepatitis C coinfection (SHR 1.48; 95% CI 1.06-2.05). LTFU was less likely to occur in females, in individuals with higher CD4 counts, in those with self-reported adherence ≥ 95%, and in those living in high-income countries. The 6-month LTFU definition produced an incidence rate of 3.2 per 100 PY (95% CI 2.9-3.4 and had similar associations but with greater risks of LTFU for ART initiation in later years (2006-2009: SHR 2.38; 95% CI 1.93-2.94; and 2010-2011: SHR 4.26; 95% CI 3.17-5.73) compared with 2003-2005.

CONCLUSIONS: The long-term LTFU rate in our cohort was low, with older age being associated with LTFU. The increased risk of LTFU with later years of ART initiation in the 6-month analysis, but not the 12-month analysis, implies that there was a possible move towards longer HIV clinic scheduling in Asia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.