The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
HIV Med. 2019 Aug;20(7):439-449. doi: 10.1111/hiv.12734. Epub 2019 Apr 12.
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.
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.
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.
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.
随着早期抗逆转录病毒治疗（ART）的开展，预计 HIV 感染者在接受治疗期间所花费的时间会增加。本研究旨在调查在开始 ART 治疗 5 年后仍留在治疗中的亚洲患者的失访（LTFU）情况。
长期 LTFU 定义为在开始 ART 后 5 年内失访。LTFU 定义为：（1）在过去 12 个月内未就诊；（2）在过去 6 个月内未就诊。使用竞争风险回归分析与 LTFU 相关的因素。
在 12 个月的定义下，失访率为每 100 人年 2.0 例（4889 例研究患者中 95%置信区间 [CI] 为 1.8-2.2）。与 31-40 岁相比，年龄>50 岁（亚危险比 [SHR] 1.64；95%CI 1.17-2.31）、病毒载量≥1000 拷贝/ml（SHR 1.86；95%CI 1.16-2.97）与病毒载量<1000 拷贝/ml，以及合并丙型肝炎感染（SHR 1.48；95%CI 1.06-2.05）与 LTFU 相关。女性、CD4 计数较高、自述依从性≥95%、生活在高收入国家的患者发生 LTFU 的可能性较低。6 个月的 LTFU 定义产生的发病率为每 100 人年 3.2 例（95%CI 2.9-3.4），且具有相似的关联，但与 ART 起始后较晚年份（2006-2009 年：SHR 2.38；95%CI 1.93-2.94；2010-2011 年：SHR 4.26；95%CI 3.17-5.73）相比，2003-2005 年的 LTFU 风险更高。
本队列的长期 LTFU 率较低，年龄较大与 LTFU 相关。6 个月的分析显示，ART 起始后较晚年份的 LTFU 风险增加，但 12 个月的分析没有显示，这意味着亚洲的 HIV 门诊预约可能会延长。
