Dataset Information

Retention in care and mortality trends among patients receiving comprehensive care for HIV infection: a retrospective cohort study.

ABSTRACT:

Background

Studies examining the relation between comprehensive care and health outcomes associated with comorbidities unrelated to HIV infection have focused mainly on the health outcomes of HIV-infected people and comorbid substance use disorders. We aimed to assess the impact of retention in comprehensive HIV infection care on overall, AIDS-related and non-AIDS-related mortality.

Methods

Using a retrospective cohort design, we collected data for HIV-infected patients aged 19 years or more who first visited a comprehensive HIV infection clinic in Vancouver between Jan. 1, 2004, and Dec. 31, 2014. We defined retention in care as visit constancy (whether the patient attended the clinic at least once per given period) of 75% or greater. We used Poisson regression modelling to examine mortality trends. We performed Cox proportional hazards modelling to assess survival by retention during the first year of follow-up and identify factors associated with death.

Results

A total of 2101 patients were included in the study. Of the 2101, 1340 (63.8%) were retained in the first year of care, and 271 (12.9%) died during the study period. Among the 264 cases in which the cause of death was known, although the primary underlying cause of death (74 [28.0%]) was AIDS-related, half of all AIDS-related deaths (37/74 [50%]) occurred early in the study (2004-2007). In later years, most deaths (147/184 [79.9%]) were non-AIDS-related. Overall mortality was significantly reduced among patients with higher retention in care during the first year of follow-up (per 20% increase in visit constancy; adjusted hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.79-0.96). Higher retention was also associated with reduced risk of AIDS-related death (adjusted HR 0.79, 95% CI 0.64-0.97).

Interpretation

Although there was an overall trend toward decreased AIDS-related mortality over time, retention in care markedly decreased the likelihood of death. Maintaining patient engagement in comprehensive ancillary care is a patient-centred way of decreasing mortality rates among HIV-infected people.

SUBMITTER: Ulloa AC

PROVIDER: S-EPMC6461542 | biostudies-literature | 2019 Apr-Jun

REPOSITORIES: biostudies-literature

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Publications

Retention in care and mortality trends among patients receiving comprehensive care for HIV infection: a retrospective cohort study.

Ulloa Ana C AC Puskas Cathy C Yip Benita B Zhang Wendy W Stanley Cole C Stone Sarah S Pedromingo Miguel M Lima Viviane Dias VD Montaner Julio S G JSG Guillemi Silvia S Barrios Rolando R

CMAJ open 20190412 2

<h4>Background</h4>Studies examining the relation between comprehensive care and health outcomes associated with comorbidities unrelated to HIV infection have focused mainly on the health outcomes of HIV-infected people and comorbid substance use disorders. We aimed to assess the impact of retention in comprehensive HIV infection care on overall, AIDS-related and non-AIDS-related mortality.<h4>Methods</h4>Using a retrospective cohort design, we collected data for HIV-infected patients aged 19 ye ...[more]

PMID: 30979728

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Dataset Information

Retention in care and mortality trends among patients receiving comprehensive care for HIV infection: a retrospective cohort study.

Background

Methods

Results

Interpretation

Publications

Retention in care and mortality trends among patients receiving comprehensive care for HIV infection: a retrospective cohort study.

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