Late Re-Engagement Into HIV Care Among Adults in the Swiss HIV Cohort Study

被引:0
|
作者
Haas, Andreas D. [1 ]
Kusejko, Katharina [2 ,3 ]
Cavassini, Matthias [4 ]
Gunthard, Huldrych [2 ,3 ]
Stockle, Marcel [5 ]
Calmy, Alexandra [6 ]
Bernasconi, Enos [7 ,8 ]
Schmid, Patrick [9 ]
Egger, Matthias [1 ,10 ,11 ]
Wandeler, Gilles [1 ,12 ]
Swiss HIV Cohort Study
机构
[1] Kantonsspital, Munsterlingen, Switzerland
[2] Univ Hosp Zurich, Dept Infect Dis & Hosp Epidemiol, Zurich, Switzerland
[3] Univ Zurich, Inst Med Virol, Zurich, Switzerland
[4] Univ Lausanne, Univ Hosp Lausanne, Munsterlingen, Switzerland
[5] Univ Hosp Basel, Div Infect Dis & Hosp Epidemiol, Basel, Switzerland
[6] Univ Geneva, Geneva Univ Hosp, Munsterlingen, Switzerland
[7] Kantonsspital, Ente Osped Cantonale Lugano, Div Infect Dis, Geneva, Switzerland
[8] Univ Southern Switzerland, Lugano, Switzerland
[9] Kantonsspital, St Gallen, Switzerland
[10] Univ South Africa, Florida, South Africa
[11] AND Engn & Assoc, Kolkata, England
[12] Univ Bern, Bern Univ Hosp, Munsterlingen, Switzerland
基金
瑞士国家科学基金会;
关键词
late re-engagement; advanced HIV disease; loss to follow-up; retention; ANTIRETROVIRAL THERAPY; RETENTION;
D O I
10.1097/QAI.0000000000003597
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Introduction: Little is known about the clinical status of persons with HIV who re-engage in care after an interruption. We evaluated the immunologic and clinical characteristics of individuals re-engaging in care within the Swiss HIV Cohort Study. Methods: Participants who re-engaged in care after an interruption >14 months with a viral load >= 100 copies/mL were classified as having interrupted antiretroviral therapy (ART). We defined late re-engagement as re-engaging with a CD4 cell count of <350 cells/<mu>L or a new Centers for Disease Control and Prevention stage C disease. Linear and logistic regression models with restricted cubic splines were used to estimate the mean CD4 cell count at re-engagement and the probability of late re-engagement as a function of care interruption duration. Results: Of 14,864 participants with a median follow-up of 10.2 years (interquartile range 4.7-17.2 years), 2768 (18.6%) interrupted care, of whom 1489 (53.8%) re-engaged. Among those re-engaging, 62.3% had interrupted ART. For participants who interrupted ART, the mean CD4 count declined from 374 cells/mu L [95% confidence interval (CI): 358 to 391 cells/mu L] before the interruption to 250 cells/mu L (95% CI: 221 to 281 cells/mu L) among those re-engaging after 14 months, and to 185 cells/mu L (95% CI: 160 to 212 cells/mu L) among those re-engaging after 60 months. The estimated risk of late re-engagement in care was 68.6% (95% CI: 62.3% to 74.4%) for participants who interrupted ART for 14 months and 75.2% (95% CI: 68.9% to 80.6%) for those who interrupted ART for 60 months. Conclusions: Although HIV care interruptions are not very common in Switzerland, most persons with HIV re-engaging after interrupting ART return with late-stage HIV.
引用
收藏
页码:491 / 500
页数:10
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