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Title: | Loss to follow-up in the Australian HIV Observational Database. | Authors: | McManus H.;Petoumenos K.;Brown K.;Baker D.;Russell D.;Read T.;Smith D.;Wray L.;Giles M. ;Hoy J.;Carr A.;Law M.G.;Australian HIV Observational Database | Institution: | (McManus, Petoumenos, Law) Kirby Institute, UNSW Australia, Sydney, NSW, Australia (Brown) Illawarra Sexual Health Service, Warrawong, NSW, Australia (Baker) East Sydney Doctors, Sydney, NSW, Australia (Russell) Cairns Sexual Health Service, Cairns, QLD, Australia (Russell) James Cook University, Cairns, QLD, Australia (Russell) University of Melbourne, Melbourne, VIC, Australia (Read) Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia (Smith) Albion Centre, Sydney, NSW, Australia (Smith) School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia (Wray) Sydney Sexual Health Centre, Sydney, NSW, Australia (Giles) Infectious Diseases, Monash Medical Centre, Melbourne, VIC, Australia (Giles) Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia (Hoy) Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne, VIC, Australia (Carr) HIV, Immunology and Infectious Diseases Unit, St Vincent's Hospital, Sydney, NSW, Australia | Issue Date: | 18-Jun-2016 | Copyright year: | 2015 | Publisher: | International Medical Press Ltd (E-mail: imp@intmedpress.com) | Place of publication: | United Kingdom | Publication information: | Antiviral Therapy. 20 (7) (pp 731-741), 2015. Date of Publication: 2015. | Journal: | Antiviral Therapy | Abstract: | Background: Loss to follow-up (LTFU) in HIV-positive cohorts is an important surrogate for interrupted clinical care, which can potentially influence the assessment of HIV disease status and outcomes. After preliminary evaluation of LTFU rates and patient characteristics, we evaluated the risk of mortality by LTFU status in a high-resource setting. Method(s): Rates of LTFU were measured in the Australian HIV Observational Database for a range of patient characteristics. Multivariate repeated measures regression methods were used to identify determinants of LTFU. Mortality by LTFU status was ascertained using linkage to the National Death Index. Survival following combination antiretroviral therapy initiation was investigated using the Kaplan-Meier (KM) method and Cox proportional hazards models. Result(s): Of 3,413 patients included in this analysis, 1,632 (47.8%) had at least one episode of LTFU after enrolment. Multivariate predictors of LTFU included viral load (VL)>10,000 copies/ml (rate ratio [RR] 1.63; 95% CI 1.45, 1.84; ref <=400), time under follow-up (per year; RR 1.03; 95% CI 1.02, 1.04) and prior LTFU (per episode; RR 1.15; 95% CI 1.06, 1.24). KM curves for survival were similar by LTFU status (P=0.484). LTFU was not associated with mortality in Cox proportional hazards models (univariate hazard ratio [HR] 0.93; 95% CI 0.69, 1.26) and multivariate HR 1.04 (95% CI 0.77, 1.43). Conclusion(s): Increased risk of LTFU was identified amongst patients with potentially higher infectiousness. We did not find significant mortality risk associated with LTFU. This is consistent with timely re-engagement with treatment, possibly via high levels of unreported linkage to other health-care providers.Copyright ©2015 International Medical Press. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.3851/IMP2916 | ISSN: | 1359-6535 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/41043 | Type: | Article | Subjects: | national death index follow up adult *aftercare aged article Australia Australian clinical feature cohort analysis controlled study data base female human *Human immunodeficiency virus infection/dt [Drug Therapy] Human immunodeficiency virus infection/dt [Drug Therapy] major clinical study male mortality risk observational study outcome assessment priority journal register survival rate virus load antiretrovirus agent/dt [Drug Therapy] *Loss to Follow-up follow up human *Human immunodeficiency virus infection / *drug therapy Human immunodeficiency virus infection / drug therapy major clinical study male mortality risk observational study outcome assessment priority journal Article survival rate virus load aged *aftercare adult register Australia Australian clinical feature cohort analysis controlled study data base female |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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