• 1 The Kirby Institute, UNSW Australia, Sydney, Australia
  • 2 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 3 Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 4 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 5 Cipto Mangunkusumo-Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • 6 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 7 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 8 National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
  • 9 National Hospital of Pediatrics, Hanoi, Vietnam
  • 10 The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 11 Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 12 Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 13 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
  • 14 Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
  • 15 Hospital Likas, Kota Kinabalu, Malaysia
  • 16 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 17 Penang Hospital, Penang, Malaysia
  • 18 TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand
J Acquir Immune Defic Syndr, 2019 12 15;82(5):431-438.
PMID: 31714422 DOI: 10.1097/QAI.0000000000002184


BACKGROUND: Perinatally HIV-infected adolescents (PHIVA) are an expanding population vulnerable to loss to follow-up (LTFU). Understanding the epidemiology and factors for LTFU is complicated by varying LTFU definitions.

SETTING: Asian regional cohort incorporating 16 pediatric HIV services across 6 countries.

METHODS: Data from PHIVA (aged 10-19 years) who received combination antiretroviral therapy 2007-2016 were used to analyze LTFU through (1) an International epidemiology Databases to Evaluate AIDS (IeDEA) method that determined LTFU as >90 days late for an estimated next scheduled appointment without returning to care and (2) the absence of patient-level data for >365 days before the last data transfer from clinic sites. Descriptive analyses and competing-risk survival and regression analyses were used to evaluate LTFU epidemiology and associated factors when analyzed using each method.

RESULTS: Of 3509 included PHIVA, 275 (7.8%) met IeDEA and 149 (4.3%) met 365-day absence LTFU criteria. Cumulative incidence of LTFU was 19.9% and 11.8% using IeDEA and 365-day absence criteria, respectively. Risk factors for LTFU across both criteria included the following: age at combination antiretroviral therapy initiation <5 years compared with age ≥5 years, rural clinic settings compared with urban clinic settings, and high viral loads compared with undetectable viral loads. Age 10-14 years compared with age 15-19 years was another risk factor identified using 365-day absence criteria but not IeDEA LTFU criteria.

CONCLUSIONS: Between 12% and 20% of PHIVA were determined LTFU with treatment fatigue and rural treatment settings consistent risk factors. Better tracking of adolescents is required to provide a definitive understanding of LTFU and optimize evidence-based models of care.

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