De La Mata Nicole L, Ly Penh S, Nguyen Kinh V, Merati Tuti P, Pham Thuy T, Lee Man P, Choi Jun Y, Ross Jeremy, Law Matthew G, Ng Oon T
*Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; †National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia; ‡National Hospital for Tropical Diseases, Hanoi, Vietnam; §Department of Internal Medicine, Tropical and Infectious Diseases, Udayana University and Sanglah Hospital, Bali, Indonesia; ‖Bach Mai Hospital, Hanoi, Vietnam; ¶Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China; **Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea; ††TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand; and ‡‡Department of Infectious Diseases, Tan Tock Seng Hospital, Novena, Singapore.
J Acquir Immune Defic Syndr. 2017 Apr 15;74(5):555-562. doi: 10.1097/QAI.0000000000001293.
Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia.
Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site.
A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99).
LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.
随着时间的推移，抗逆转录病毒治疗（ART）项目有了显著改善，包括服务的扩展和患者参与度的提高。我们描述了亚洲接受ART的HIV阳性患者失访（LTFU）的时间趋势及其相关因素。
分析纳入了2003年至2013年在亚洲7个ART项目中开始接受ART的HIV阳性成年人。失访患者是指连续≥180天未到诊所就诊、未死亡或未转至其他诊所的患者。以最近一次诊所就诊时间、随访至2014年1月为截尾时间。我们使用累积发病率来比较开始ART年份之间的失访率和死亡率。使用竞争风险回归模型评估与失访相关的因素，并根据临床地点进行调整。
共纳入8305例患者。在26217人年（pys）的随访期间，有743例患者失访，352例死亡，粗失访率和死亡率分别为每100人年2.83（2.64 - 3.05）和每100人年1.34（1.21 - 1.49）。在24个月时，累积失访发病率从2003 - 2005年的4.3%（2.9% - 6.1%）增加到2006 - 2009年的8.1%（7.1% - 9.2%），然后在2010 - 2013年降至6.7%（5.9% - 7.5%）。同时，累积死亡率从2003 - 2005年的6.2%（4.5% - 8.2%）降至2010 - 2013年的3.3%（2.8% - 3.9%）。与2006 - 2009年相比，2010 - 2013年失访风险降低（调整后亚风险比 = 0.73，0.69 - 0.99）。
在我们的临床机构中，接受ART的HIV阳性患者的失访率因开始ART的年份而异，近年来失访率有所下降，而死亡率保持稳定。进一步增加机构层面的资源可能有助于进一步降低后续年份开始治疗患者的失访率。
