Care interruptions and mortality among adults in Europe and North America.
AIDS
; 38(10): 1533-1542, 2024 Aug 01.
Article
in En
| MEDLINE
| ID: mdl-38742863
ABSTRACT
OBJECTIVE:
Interruptions in care of people with HIV (PWH) on antiretroviral therapy (ART) are associated with adverse outcomes, but most studies have relied on composite outcomes. We investigated whether mortality risk following care interruptions differed from mortality risk after first starting ART.DESIGN:
Collaboration of 18 European and North American HIV observational cohort studies of adults with HIV starting ART between 2004 and 2019.METHODS:
Care interruptions were defined as gaps in contact of ≥365âdays, with a subsequent return to care (distinct from loss to follow-up), or ≥270âdays and ≥545âdays in sensitivity analyses. Follow-up time was allocated to no/preinterruption or postinterruption follow-up groups. We used Cox regression to compare hazards of mortality between care interruption groups, adjusting for time-updated demographic and clinical characteristics and biomarkers upon ART initiation or re-initiation of care.RESULTS:
Of 89 197 PWH, 83.4% were male and median age at ART start was 39âyears [interquartile range (IQR) 31-48)]. 8654 PWH (9.7%) had ≥1 care interruption; 10 913 episodes of follow-up following a care interruption were included. There were 6104 deaths in 536 334 person-years, a crude mortality rate of 11.4 [95% confidence interval (CI) 11.1-11.7] per 1000 person-years. The adjusted mortality hazard ratio (HR) for the postinterruption group was 1.72 (95% CI 1.57-1.88) compared with the no/preinterruption group. Results were robust to sensitivity analyses assuming ≥270-day (HR 1.49, 95% CI 1.40-1.60) and ≥545-day (HR 1.67, 95% CI 1.48-1.88) interruptions.CONCLUSIONS:
Mortality was higher among PWH reinitiating care following an interruption, compared with when PWH initially start ART, indicating the importance of uninterrupted care.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
HIV Infections
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
/
Europa
Language:
En
Journal:
AIDS
Journal subject:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Year:
2024
Document type:
Article
Affiliation country:
United kingdom