title: Poor retention in early care increases risk of mortality in a Brazilian HIV-infected clinical cohort.
abstract: Retention in early HIV care has been associated with decreased mortality and improved viral suppression, however the consequences of poor retention in early care in Brazil remain unknown. We assessed the effect of poor retention on mortality in a Brazilian HIV-infected clinical cohort. The analysis included ART-naïve, HIV-infected adults linked to care at the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz between 2000 and 2010, who did not become pregnant nor participate in a clinical trial during the first two years in care (early care). Poor retention in early care was defined as less than 3 out of 4 six-month intervals with a CD4 or HIV-1 RNA laboratory result during early care. Cox proportional hazards models were used to identify factors associated with mortality, and Kaplan-Meier plots were used to describe the survival probability for participants with poor retention versus good retention. Among 1054 participants with a median (interquartile range) follow-up time of 4.2 years (2.6, 6.3), 20% had poor retention in early care and 8% died. Poor retention in early care [adjusted hazard ratio (aHR) 3.09; 95% CI 1.65-5.79], AIDS defining illness (aHR 1.95; 95% CI 1.20-3.18) and lower education (aHR 2.33; 95% CI 1.45-3.75) were associated with increased mortality risk. Our findings highlight the importance of adopting strategies to improve retention in early HIV care.
authors.affiliation: a Department of Medicine , David Geffen School of Medicine, University of California , Los Angeles , CA , USA.|b Boston University School of Medicine , Boston , MA , USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Teixeira da Silva
authors.affiliation: c Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Luz
authors.affiliation: a Department of Medicine , David Geffen School of Medicine, University of California , Los Angeles , CA , USA.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Lake
authors.affiliation: c Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
authors.forename: Sandra W
authors.initials: SW
authors.lastname: Cardoso
authors.affiliation: c Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
authors.forename: Sayonara
authors.initials: S
authors.lastname: Ribeiro
authors.affiliation: c Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
authors.forename: Ronaldo I
authors.initials: RI
authors.lastname: Moreira
authors.affiliation: a Department of Medicine , David Geffen School of Medicine, University of California , Los Angeles , CA , USA.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Clark
authors.affiliation: c Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: c Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: c Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
authors.forename: Raquel B
authors.initials: RB
authors.lastname: De Boni
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood*; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: HIV; Retention; cohort studies; survival analysis; urban population