Predictive Factors of ART Follow-Up Loss in HIV Patients (2018-2022): A Retrospective Cohort Study

Loss to follow-up (LTFU) in antiretroviral therapy (ART) poses significant challenges in the management of HIV/AIDS. This study aims to identify socio-demographic and clinical factors influencing LTFU among patients undergoing ART in Luzhou, China, and to develop a predictive model for LTFU using Cox risk regression analysis. In this retrospective cohort study, data from 8,770 patients diagnosed with HIV infection between January 1, 2018 and December 31, 2022 who were enrolled in the national free ART program were analyzed. The primary outcome was the first occurrence of LTFU. Cox proportional risk regression analyses were conducted to identify predictors of LTFU. The study population had a median age of 64.25 years, and 73.2% were male. The overall LTFU rate was 4.14 per 100 person-years. Factors associated with a decreased likelihood of LTFU included female gender, homosexual transmission, absence of HIV-related diseases, negative HBV surface antigen, higher final CD4 count, and an increase in CD4 count from baseline. In contrast, older age, longer time from diagnosis to ART initiation, higher baseline viral load, missed medication doses, and the development of medication side-effects were associated with an increased risk of LTFU. Our prediction model identifying the risk of loss to follow-up demonstrated good predictive performance with a C-index of 0.721. The study highlights the importance of considering a range of socio-demographic and clinical factors in managing LTFU among people living with HIV (PLHIV) on ART. Our prediction model can be a valuable tool for healthcare providers to identify patients at high risk of LTFU, facilitating targeted interventions to improve treatment adherence and outcomes.