Too Few HIV-Infected Patients Are Receiving Care
Only 35% of HIV-infected adults in South Carolina received consistent HIV care from 2004 through 2006.
With potent antiretroviral therapy (ART) now available, attention is turning to failed retention in care as a cause of poor HIV-related outcomes. In the present study, investigators capitalized on the unique and comprehensive South Carolina state reporting system to examine HIV care retention rates during a 3-year period.
The analysis involved all adults who had a reported HIV or AIDS diagnosis between 1986 and 2003 and were alive through 2006. Patients were categorized as being "in care" if they had a CD4-cell–count or viral-load value reported for each calendar year of the study period (2004–2006). Patients who had values for some but not all of these years were defined as being in "transitional care." Those who did not have values for any of the years were defined as being "not in care."
Among 13,042 patients, only 35% were considered to be in care; the proportion of patients with a CD4-cell–count or viral-load value in any given year increased over time, from 44% in 2004 to 50% in 2006. Patients without an identified HIV risk factor had the highest "not in care" rates (53%). In multivariate analyses, the odds of being in transitional care or not in care were significantly higher for whites than for blacks, for men than for women, and for patients aged <45 than for those aged 55. Retention in care was significantly more common among patients with AIDS than among those without.
Comment: Prior reports indicate that 42% to 59% of HIV-infected patients in the U.S. are not in care. These new data from South Carolina, however, suggest that that number could be closer to 65%. This estimate is disturbing, as it is likely conservative on at least two accounts. First, it presumes that patients need only be followed yearly to receive guideline-concordant care, and second, many of the CD4-cell–count and viral-load values were probably obtained in acute care settings. On an encouraging note, the sickest patients were those most likely to have laboratory values recorded. However, as guideline-recommended treatment thresholds rise beyond CD4 counts <200 cells/mm3, mechanisms must be in place to ensure that all patients who are eligible for ART access the healthcare system to receive it.
— Rochelle P. Walensky, MD, MPH
Dr. Walensky is Associate Director, Program in Epidemiology and Outcomes Research, Center for AIDS Research, Harvard Medical School and Infectious Disease Specialist, Massachusetts General Hospital and Brigham and Womens Hospital, Boston.
Published in Journal Watch HIV/AIDS Clinical Care March 30, 2009
Olatosi BA et al. Patterns of engagement in care by HIV-infected adults: South Carolina, 2004–2006. AIDS 2009 Mar 27; 23:725.
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