A Jiamsakul1, S Kiertiburanakul2, O T Ng3, R Chaiwarith4, W Wong5, R Ditangco6, K V Nguyen7, A Avihingsanon8, S Pujari9, C D Do10, M-P Lee11, P S Ly12, E Yunihastuti13, N Kumarasamy14, A Kamarulzaman15, J Tanuma16, F Zhang17, J Y Choi18, P Kantipong19, Blh Sim20, J Ross21, M Law1, T P Merati22. 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.
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.
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.
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