Howe Chanelle J, Cole Stephen R, Napravnik Sonia, Eron Joseph J
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7435, USA.
AIDS Res Hum Retroviruses. 2010 Aug;26(8):875-81. doi: 10.1089/aid.2009.0282.
Predictors of study retention and scheduled visit attendance in the University of North Carolina Center for AIDS Research (UNC CFAR) prospective clinical cohort of HIV-infected patients enrolled between 1 January 2001 and 1 January 2008 are reported. At study entry, 1636 participants were 32% female, 58% were African-American, 49% had not received HIV care elsewhere, 71% were receiving or initiated combination antiretroviral therapy, and 26% were diagnosed with AIDS, with median (quartiles) age of 40 (34; 47) years, distance to clinic of 45 (21; 70) miles, HIV-1 RNA of 1396 (200; 26,750) copies/ml, and CD4 of 374 (182; 602) cells/mm(3). Participants contributed a median of 7 (4; 13) scheduled visits and 2.25 (1.0; 3.9) years alive under follow-up. During 6134 person-years of follow-up, 414 participants dropped out and 145 died. Accounting for differences in death by participant characteristics, the 6-year cumulative probability of retention was 67% [95% confidence limits (CL): 65, 70%], with 6.75 (95% CL: 6.13, 7.43) drop outs per 100 person-years. In a multivariable Cox proportional hazards model, retention was higher among participants who were insured, had not received HIV care elsewhere, had controlled HIV viremia, and were living in nonurban areas or proximate to the clinic. In a multivariable modified Poisson regression model that accounted for differences in drop out and death by participant characteristics, visit attendance was higher among older, AIDS-diagnosed, immune compromised, and cART-initiated participants. The UNC CFAR clinical cohort has ample enrollment with retention and visit attendance modestly influenced by factors such as disease severity.
报告了北卡罗来纳大学艾滋病研究中心（UNC CFAR）在2001年1月1日至2008年1月1日期间招募的HIV感染患者前瞻性临床队列中研究保留率和预定就诊出勤率的预测因素。在研究开始时，1636名参与者中32%为女性，58%为非裔美国人，49%未在其他地方接受过HIV治疗，71%正在接受或开始接受联合抗逆转录病毒治疗，26%被诊断为艾滋病，年龄中位数（四分位数）为40（34；47）岁，到诊所的距离为45（21；70）英里，HIV-1 RNA为1396（200；26,750）拷贝/毫升，CD4为374（182；602）细胞/立方毫米。参与者在随访期间预定就诊的中位数为7（4；13）次，存活时间的中位数为2.25（1.0；3.9）年。在6134人年的随访期间，414名参与者退出，145人死亡。考虑到因参与者特征导致的死亡差异，6年的保留累积概率为67%[95%置信区间（CL）：65，70%]，每100人年有6.75（95%CL：6.13，7.43）人退出。在多变量Cox比例风险模型中，参保、未在其他地方接受过HIV治疗、HIV病毒血症得到控制且居住在非城市地区或离诊所较近的参与者的保留率较高。在一个考虑了因参与者特征导致的退出和死亡差异的多变量修正泊松回归模型中，年龄较大、被诊断为艾滋病、免疫功能受损且开始接受cART治疗的参与者的就诊出勤率较高。UNC CFAR临床队列有充足的入组人数，保留率和就诊出勤率受到疾病严重程度等因素的适度影响。
