Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States

Abstract

Linkage and retention in care soon after HIV diagnosis improves clinical outcomes. Conversely, missed visits after diagnosis are associated with increased mortality in the public care setting. We analyzed mortality among newly diagnosed HIV patients ‡ 18 years old in a large private care setting between 01/01/1997 and 12/31/ 2009, comparing patients who missed visits in their first year following diagnosis (index period) with those who did not. Patients who died during the index period were excluded. Hazard ratios (HR) for association of missed visits and mortality were obtained by Cox proportional hazards regression, adjusting for patient demographics, CD4 + counts, and AIDS-defining conditions (CDC, 1993) at diagnosis. We also evaluated risk factors of missed visits by multivariable logistic regression. 2811 patients were included, of whom 65% had ‡ 1 missed visit, and 226 patients died during follow-up. Patients with ‡ 1 missed visit had a 71% increased mortality risk (HR = 1.71, p = 0.001) with 12% increased rate per missed visit (HR = 1.12, p < 0.001). Factors associated with missed visits were younger age (OR = 1.69 compared to 60 + years), Black and Latino race/ethnicity (OR = 1.54, 1.48 respectively, compared to Caucasians), injection drug use (OR = 2.50 compared to men who have sex with men), and lower CD4 + (OR = 1.43 for CD4 + 100-199 cells/lL, OR = 1.39 for 50-99 cells/lL, and OR = 1.63 for CD4 + < 50 cells/lL, compared with CD4 + > 500 cells/lL). In an insured patient population, missed visits in the first year of HIV care are common and associated with increased mortality. Early retention in HIV care is critical to improving outcomes.

Opportunistic Infections and Mortality: Still Room for Improvement

“…For several opportunistic processes, however, such as central nervous system lymphoma and JC virus encephalitis, survival remains especially poor. These data are in line with reports from other cohorts and jurisdictions [9][10][11][12][13].…”

The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care

“…It was previously demonstrated that better retention in HIV care in the first year has been associated with higher rates of ART initiation and improved survival. 26,35,36 Qualitative research would be helpful to develop an understanding of trust in physicians and the healthcare system and of the correlates of retention in HIV care among persons newly diagnosed with HIV infection. Based on our results, one component of interventions designed to improve early retention in care might have a focus on improving trust in physicians.…”

Disparities in Viral Load and CD4 Count Trends Among HIV-Infected Adults in South Carolina

“…26,27 To our knowledge, no previous studies have examined the trends in individual VL using complete statewide data. The purpose of our investigation is to examine statewide trends in individual VL over time among PLWHA and identify disparities, if any, by gender, race/ethnicity, age group, HIV risk exposure group, and current residence.…”