Incidence rate and risk factors for loss to follow-up in HIV-infected patients from five French clinical centres in Northern France – January 1997 to December 2006

Abstract

Background Our goal was to determine the incidence rate and risk factors for loss to follow-up (LTFU) of HIV-infected patients in Northern France. Methods We estimated the incidence rate of LTFU in 1,007 HIV-infected patients under care from January 1997 to December 2006. We then investigated potential risk factors for LTFU at inclusion and during follow-up. Results The incidence of LTFU was estimated to be 3.5 per 100 person-years. Risk factors for LTFU at enrolment in a multivariate Cox model were age <30 years (hazard ratio [HR] 1.66 versus >40 years, 95% confidence interval [CI] 1.04–2.64), transmission by injection drug use (HR 5.26 versus men who have sex with men, 95% CI 2.90– 9.52), no phone number provided (HR 5.4, 95% CI 3.6–8.2), no primary care physician (HR 2.10, 95% CI 1.25–3.52) and sub-Saharan African origin (HR 2.09, 95% CI 1.36–3.22). Patients with CD4+ T-cell counts <200 cells/mm3 (HR 0.49 versus ≥350 cells/mm3, 95% CI 0.32– 0.76) and 200– 349 cells/mm3 at baseline (HR 0.63 versus ≥350 cells/mm3, 95% CI 0.41–0.98) had a decreased risk of LTFU. During follow-up, the risk of LTFU increased when the most recent CD4+ T-cell count was <200 cells/ mm3 (HR 2.06, 95% CI 1.16–3.66), the patient was not on highly active antiretroviral therapy (HAART; HR 4.20, 95% CI 2.66–6.61) and the patient was on HAART but had a detectable viral load (HR 1.92, 95% CI 1.19–3.01). Conclusions Our findings will help clinicians recognize patients who require additional support for retention in care, including younger patients, injection drug users, people of sub-Saharan African origin, patients who are healthier at enrolment and patients who do not adhere to HAART during follow-up.

Survival probability and factors associated with time to loss to follow-up and mortality among patients on antiretroviral treatment in central Kenya

“…A study in South Africa reported an incidence rate of LTFU of 10.3 per 100 person-years in the 1st year on ART and increased to 40.5 per 100 person-years in the 8th year of ART [ 15 ]. This contrasts with LTFU incidence rates reported in developed countries at 4.2 per 100 person-years reported among ART experienced participants by the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) prospective cohort of 4630 participants [ 16 ] and, 3.5 per 100 person years among 1007 patients in France between 1997 to 2006 [ 17 ].…”

Death and Transferred Out as Competing Event for Lost to Follow-up among HIV-positive Adults on ART, in Eastern Ethiopia Governmental Hospitals from January 2015 to December 2021; (Multicenter Competing Risk Regression Analysis)

“…Death Ethiopia [17,18,31], this may be due to that the patients with the poor level of adherence for ART drug become interrupt the treatment schedule which leads to resisting to the virus. This treatment interruption make fail to suppress the viral load and become prone to poor treatment outcome like treatment failure, this leads the patient to lose hope for a good prognosis, and He/she prefers to lost from care after all the outcome turned to death [4,7].…”

“…The goals of ART are to lead and effectively suppress viral replication in order to prevent the development of HIV drug resistance, treatment failure, and lost follow-up. Adherence to ART and retention in HIV care program are critical for achieving optimal health outcomes in HIV patients [7,8]. Loss of followup from ART service has a pronounced negative impact on ART treatment outcomes.…”

“…Different studies showed that LTFU is associated with baseline sociodemographic factors like male sex [8,[25][26][27][28][29][30][31] those whose age is younger 15-24 years [7,14,16,27,28,32,33] and those not having a committed partner [34], patients with no education [27,35,36], and unmarried [27,36], and clinical and treatment-related factors like CD4 count below 200 cells [8,19,37,38], BMI<18.5 kg/m 2 [8,25,32], WHO stage I or II [8,14,15,[38][39][40][41], anemia [42], fair/poor level of adherence and WHO stage III or IV [17,18,24,28,35], don't take INH prophylaxis [16,17,22], BMI<18.5 kg/m 2 [21,35], no CPT prophylaxis [16,43], ambulatory f...…”

Who is lost to follow‐up in HIV care? Assessment of care retention over time and the impact of COVID‐19. Longitudinal analysis of the PISCIS cohort

“…Studies in different European countries have linked LTFU with younger age, people who inject drugs (PWID), having an immigration background, not being a man who has sex with men (MSM), having a shorter time since HIV diagnosis, and CD4+ cell counts <350 cells/μL [15–18]. In Spain, determinants of LTFU included younger age, less time in treatment, use of injecting drugs, unemployment, immigration, and being treated in a big hospital (>1000 patients in HIV care) [13].…”