In patients with HIV infection, early linkage to and retention in continuous HIV medical care are the most important components of care shown to improve health outcomes in this population.1 In the United States, approximately 77% of HIV-infected individuals are linked to appropriate care within 3 to 6 months after diagnosis, but only 51% of those who are linked actually remain in care. Poor care retention is an obstacle to achieving optimal viral suppression and thus is important to understand.
A new study published in the Journal of the International Association of Providers of AIDS Care was designed to determine the effect of retention in care on viral suppression after initiating highly active antiretroviral therapy (HAART).2 The retrospective study reviewed the medical records of patients who started HAART in an academic infectious disease clinic at the University of Kentucky between 2003 and 2011. Patients were followed from the time of initiation of HAART until the measured outcome events (viral suppression) or until the end of the study in December 2011, death, or loss to follow-up.
The study included 523 patients of whom 80.1% (426 patients) were virally suppressed. Patients who were nonoptimal retainers had a longer time to viral suppression than optimal retainers (time ratio, 2.04; 95% confidence interval, 1.40–2.90) even after controlling for insurance status, race, baseline CD4 cell counts, and viral loads. These findings highlight the importance of care retention for viral suppression. One of the limitations of this study is that it could not control for the impact of antiretroviral adherence on viral suppression.
More research is needed to improve strategies that will enhance care retention and that can help reengage infected patients lost to follow-up.
Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52:793–800.
Crawford TN, Sanderson WT, Thornton A. Impact of poor retention in HIV medical care on time to viral load suppression. J Int Assoc Provid AIDS Care. 2014;13:242-248.