title: Characteristics and consequences of medical care interruptions in HIV-infected patients in France.
abstract: To describe the consequences of medical care interruptions (MCIs) we selected patients with at least two medical encounters between January 2006 and June 2013 in the Dat'AIDS cohort. Patients with any time interval >15 months between two visits were defined as having a MCI, as opposed to uninterrupted follow-up (UFU). Patients' characteristics at the time of HIV diagnosis and at the censoring date were compared between groups. Cox proportional hazards models were built to assess the role of interruptions on survival (total and AIDS-free). Of 11 116 patients, 824 had at least one MCI. These patients were younger at the time of HIV diagnosis (30 vs. 33 years, P < 0·0001). MCI was less frequent in men having sex with men vs. heterosexual patients [odds ratio (OR) 0·81, 95% confidence interval (CI) 0·69-0·96)], and a centre effect was described. MCI was independently associated with AIDS (OR 2·54, 95% CI 2·10-3·09) and death (OR 2·65, 95% CI 1·94-3·61). At the censoring date, 52·2% of patients with at least one MCI had viral load below detection vs. 85·3% of the UFU group (P < 0·0001). In conclusion, MCIs were associated with patients' survival and with the proportion of viral loads below detection in our cohort, compromising individual and collective treatment benefits.
authors.affiliation: INSERM,UMR 1027,Toulouse,France;Université de Toulouse III,Toulouse,France;CHU Toulouse,COREVIH Midi Pyrénées Limousin,France.
authors.forename: L
authors.initials: L
authors.lastname: Cuzin
authors.affiliation: Infectious Diseases Unit,Nice University Hospital,France.
authors.forename: P
authors.initials: P
authors.lastname: Dellamonica
authors.affiliation: Infectious and Tropical Diseases Unit,Bichat Hospital,Paris,ATIP-AVENIR Inserm U1137,Paris Diderot University,Paris,France.
authors.forename: Y
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: Infectious Diseases Unit,Nantes University Hospital,France.
authors.forename: S
authors.initials: S
authors.lastname: Bouchez
authors.affiliation: HIV/AIDS Center,Strasbourg University Hospital,France.
authors.forename: D
authors.initials: D
authors.lastname: Rey
authors.affiliation: Infectious Diseases Unit,Pointe à Pitre University Hospital,French West Indies.
authors.forename: B
authors.initials: B
authors.lastname: Hoen
authors.affiliation: Infectious Diseases Unit,Fort de France University Hospital,French West Indies.
authors.forename: A
authors.initials: A
authors.lastname: Cabié
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005602:France; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult
keywords: AIDS-free survival; HIV; care retention; lost to follow-up; virological control