Loss to Followup in HIV-Infected Patients from Asia-Pacific Region: Results from TAHOD

Abstract

This study examined characteristics of HIV-infected patients in the TREAT Asia HIV Observational Database who were lost to follow-up (LTFU) from treatment and care. Time from last clinic visit to 31 March 2009 was analysed to determine the interval that best classified LTFU. Patients defined as LTFU were then categorised into permanently LTFU (never returned) and temporary LTFU (re-entered later), and these groups compared. A total of 3626 patients were included (71% male). No clinic visits for 180 days was the best-performing LTFU definition (sensitivity 90.6%, specificity 92.3%). During 7697 person-years of follow-up, 1648 episodes of LFTU were recorded (21.4 per 100-person-years). Patients LFTU were younger (P = 0.002), had HIV viral load ≥500 copies/mL or missing (P = 0.021), had shorter history of HIV infection (P = 0.048), and received no, single- or double-antiretroviral therapy, or a triple-drug regimen containing a protease inhibitor (P < 0.001). 48% of patients LTFU never returned. These patients were more likely to have low or missing haemoglobin (P < 0.001), missing recent HIV viral load (P < 0.001), negative hepatitis C test (P = 0.025), and previous temporary LTFU episodes (P < 0.001). Our analyses suggest that patients not seen at a clinic for 180 days are at high risk of permanent LTFU, and should be aggressively traced.

Pérdida de seguimiento y factores asociados en pacientes inscritos en el programa de HIV/sida del Hospital Universitario San Ignacio, Colombia, 2012-2013

“…Estos 210.000 individuos con carga viral indetec- El programa de HIV/sida del Hospital Universitario San Ignacio presentó una tasa de densidad de la incidencia de la pérdida en el seguimiento de 17,74 por 100 personas por año, mucho más alta que la observada en otros estudios (3,72; 5,1 y 9,1 por 100 personas por año) (18)(19)(20), aunque en otras poblaciones se han descrito tasas de pérdida en el seguimiento superiores a lo reportado en este estudio (25,1 y 21,4 por 100 personas por año) (21,22). Las diferencias entre los estudios podrían deberse a las diversas metodologías aplicadas, así como a diferencias en la definición de pérdida en el seguimiento, en los tiempos de seguimiento de los estudios, en las poblaciones infectadas con HIV estudiadas y en las estructuras médicas locales (18,20).…”

Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for ‘Test and Treat’ Prevention Strategy

“…The LTFU rate is of concern as since 2006 LTFU has equated to 6.6% of potential follow-up on ART. A recent analysis of TAHOD data demonstrated that patients with shorter HIV infection history, poorer response to antiretroviral treatment, and infrequent or no clinical monitoring were at higher risk of LTFU, 32 and thus are a group that warrant additional support to prevent LTFU.…”

“…Risk factors for LTFU were not calculated as they had been already been determined recently using TAHOD data. 32 For comparison between < 2006 and from 2006, we used a rank_sum test for continuous variables, t-test for proportions, and Mantel-Cox rate ratio for TI and LTFU rates.…”

Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

“…No additional post-LTFU patient tracing was conducted as part of this study. The 180 day cut-off was selected as this has previously been validated in our cohort to achieve the highest sensitivity and specificity for determining LTFU patients 27,28 . Re-engagement into care after the first LTFU event was not considered.…”