Illicit Drug Use Is a Significant Risk Factor for Loss to Follow Up in Patients with HIV-1 Infection at a Large Urban HIV Clinic in Tokyo

Abstract

BackgroundLoss to follow up (LTFU) is an important prognostic factor in patients with HIV-1 infection. The impact of illicit drug use on LTFU of patients with HIV-1 infection is unknown in Japan.MethodsA single center observational study was conducted to elucidate the impact of illicit drug use on LTFU at a large HIV clinic in Tokyo. LTFU was defined as those who discontinued their visits to the clinic for at least 12 months and were not known to be under the care of other facilities or have died within 12 months of their last visit. Patients who first visited the clinic between January 2005 and August 2010 were enrolled. Information on illicit drug use was collected in a structured interview and medical charts. Comparison of the effects of illicit drug use and no use on LTFU was conducted by uni- and multi-variate Cox hazards models as the primary exposure.ResultsThe study subjects were 1,208 patients, mostly Japanese men, of relatively young age, and infected through homosexual contact. A total of 111 patients (9.2%) were LTFU (incidence: 24.9 per 1,000 person-years). Among illicit drug users and non users, 55 (13.3%) and 56 (7.1%) patients, respectively, were LTFU, with incidence of 35.7 and 19.2 per 1,000 person-years, respectively. Uni- and multi-variate analyses showed that illicit drug use was a significant risk for LTFU (HR=1.860; 95% CI, 1.282-2.699; p=0.001) (adjusted HR=1.544; 95% CI, 1.028-2.318; p=0.036). Multivariate analysis also identified young age, high CD4 count, no antiretroviral therapy, and no health insurance as risk factors for LTFU.ConclusionsThe incidence of LTFU among illicit drug users was almost twice higher than that among non users. Effective intervention for illicit drug use in this population is warranted to ensure proper treatment and prevent the spread of HIV.

High Treatment Retention Rate in HIV-Infected Patients Receiving Antiretroviral Therapy at Two Large HIV Clinics in Hanoi, Vietnam

“…One study using data from 18 sites in the Asia–Pacific region reported an LTFU rate of 21.4 per 100 person-years, although around half of them had temporal LTFU [ 13 ]. Another study from Japan found an LTFU rate of 2.49 per 100 person-years [ 14 ]. Although the definition of LTFU varied between our study and previous studies, it is reasonable to conclude that the rate of retention in our study is relatively high.…”

Incidence and Risk Factors for Incident Hepatitis C Infection Among Men Who Have Sex With Men With HIV-1 Infection in a Large Urban HIV Clinic in Tokyo

“…20 Because the interview could underestimate the prevalence of illicit drug use, we also searched the medical records for information on illicit drug use and related variables covering the period from the first visit to December 2012.…”

Poor Schedule Management Leads to Discontinuity of Medical Attendance among Patients Infected with HIV

“…Furthermore, Japan has an efficient public transportation network. Despite these circumstances, some reports [14] [15] [16] have shown that approximately 5% to 10% of patients who are infected with HIV discontinue medical care in Japan. In this study, we clarified factors that led to the discontinuation of medical care among HIV patients in Japan by analyzing data from interviews.…”

“…15) Trust in the medical staff: Participants discussed their relationship with Health the medical staff in which they had good rapport with their primary doctor or nurses at the hospital. 16) Relationship with and trust in the primary doctor: Participants discussed having conversations with their primary doctor or having trust in their primary doctor.…”

“…The discontinuity group also discussed having stress with personal rela-Health tionships. Discontinuing medical care is likely caused by depression[4] [22] or illegal drug use[16] [22]. Sinha[23]…”