Lost but not forgotten: A population-based study of mortality and care trajectories among people living with HIV who are lost to follow-up in Ontario, Canada

Abstract Background Drug–drug interactions (DDIs) that involve antiretrovirals (ARVs) tend to cause harm if unrecognized, especially in the context of comorbidity and polypharmacy. Methods A linkage was established between the drug dispensing registry of Madrid and the Liverpool human immunodeficiency virus (HIV) DDI database (January 2017–June 2017). Polypharmacy was defined as the use of ≥5 non-HIV medications, and DDIs were classified by a traffic-light ranking for severity. Results A total of 22 945 people living with HIV (PLWH) and 6 613 506 individuals without HIV had received medications. ARV regimens were predominantly based on integrase inhibitors (51.96%). Polypharmacy was higher in PLWH (32.94%) than individuals without HIV (22.16%; P < .001); this difference was consistently observed across all age strata except for individuals ≥75 years. Polypharmacy was more common in women than men in both PLWH and individuals without HIV. The prevalence of contraindicated combinations involving ARVs was 3.18%. Comedications containing corticosteroids, quetiapine, or antithrombotic agents were associated with the highest risk for red-flag DDI, and the use of raltegravir- or dolutegravir-based antiretroviral therapy was associated with an adjusted odds ratio of 0.72 (95% confidence interval, .60–.88; P = .001) for red-flag DDI. Conclusions Polypharmacy was more frequent among PLWH across all age groups except those aged ≥75 years and was more common in women. The detection of contraindicated medications in PLWH suggests a likely disconnect between hospital and community prescriptions. Switching to alternative unboosted integrase regimens should be considered for patients with risk of harm from DDIs.

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Prevalence and determinants of virological failure, genetic diversity and drug resistance among people living with HIV in a minority area in China: a population-based study

BMC Infectious Diseases ◽

10.1186/s12879-020-05124-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Dan Yuan ◽

Meijing Liu ◽

Peng Jia ◽

Yiping Li ◽

Yuling Huang ◽

...

Keyword(s):

Genetic Diversity ◽

Drug Resistance ◽

Virological Failure ◽

Population Based ◽

People Living With Hiv ◽

Population Based Study ◽

Living With Hiv ◽

Minority Area

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Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-048022 ◽

2021 ◽

Vol 11 (12) ◽

pp. e048022

Author(s):

Animut Alebel ◽

Daniel Demant ◽

Pammla Petrucka ◽

David Sibbritt

Keyword(s):

Systematic Review ◽

Effect Size ◽

Grey Literature ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Significance Level ◽

Sub Saharan ◽

Living With Hiv ◽

Lost To Follow Up

IntroductionUndernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA.Methods and analysisPubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger’s and Begg’s tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI.Ethics and disseminationEthical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available.PROSPERO registration numberCRD42021277741.

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Predictors of Mortality among Patients Lost to Follow up Antiretroviral Therapy

Jurnal NERS ◽

10.20473/jn.v13i1.6568 ◽

2018 ◽

Vol 13 (1) ◽

pp. 114 ◽

Cited By ~ 2

Author(s):

Putu Dian Prima Kusuma Dewi ◽

Gede Budi Widiarta

Keyword(s):

Incidence Rate ◽

Median Time ◽

Secondary Data ◽

Primary Data ◽

People Living With Hiv ◽

Risk Of Death ◽

Living With Hiv ◽

Lost To Follow Up

Introduction: The death of HIV/AIDS patients after receiving therapy in Bali is the seventh highest percentage of deaths in Indonesia. LTFU increases the risk of death in PLHA, given the saturation of people with HIV taking medication. The level of consistency in the treatment is very important to maintain the resilience and quality of life of people living with HIV. This study aims to determine the incidence rate, median time and predictors of death occurring in LTFU patients as seen from their sociodemographic and clinical characteristics.Methods: This study used an analytical longitudinal approach with retrospective secondary data analysis in a cohort of HIV-positive patients receiving ARV therapy at the Buleleng District Hospital in the period 2006-2015. The study used the survival analysis available within the STATA SE 12 softwareResults: The result showed that the incidence rate of death in LTFU patients was 65.9 per 100 persons, with the median time occurrence of 0.2 years (2.53 months). The NNRTI-class antiretroviral evapirens agents were shown to increase the risk of incidence of death in LTFU patients 3.92 times greater than the nevirapine group (HR 3.92; p = 0.007 (CI 1.46-10.51). Each 1 kg increase in body weight decreased the risk of death in LTFU patients by 6% (HR 0.94; p = 0.035 (CI 0.89-0.99).Conclusion: An evaluation and the monitoring of patient tracking with LTFU should be undertaken to improve sustainability. Furthermore, an observation of the LTFU patient's final condition with primary data and qualitative research needs to be done so then it can explore more deeply the reasons behind LTFU.

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Re-engagement in care of people living with HIV lost to follow-up after initiation of antiretroviral therapy in Mali: Who returns to care?

PLoS ONE ◽

10.1371/journal.pone.0238687 ◽

2020 ◽

Vol 15 (9) ◽

pp. e0238687

Author(s):

Aliou Baldé ◽

Laurence Lièvre ◽

Almoustapha Issiaka Maiga ◽

Fodié Diallo ◽

Issouf Alassane Maiga ◽

...

Keyword(s):

Antiretroviral Therapy ◽

People Living With Hiv ◽

Engagement In Care ◽

Living With Hiv ◽

Lost To Follow Up

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Discriminatory attitudes towards people living with HIV/AIDS and associated factors: a population based study in the Chinese general population

Sexually Transmitted Infections ◽

10.1136/sti.2004.011767 ◽

2005 ◽

Vol 81 (2) ◽

pp. 113-119 ◽

Cited By ~ 44

Author(s):

J T F Lau

Keyword(s):

General Population ◽

Associated Factors ◽

Population Based ◽

People Living With Hiv ◽

Population Based Study ◽

Living With Hiv ◽

Hiv Aids

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A Population-Based Study Evaluating Family Physicians' HIV Experience and Care of People Living With HIV in Ontario

The Annals of Family Medicine ◽

10.1370/afm.1822 ◽

2015 ◽

Vol 13 (5) ◽

pp. 436-445 ◽

Cited By ~ 9

Author(s):

C. E. Kendall ◽

D. G. Manuel ◽

J. Younger ◽

W. Hogg ◽

R. H. Glazier ◽

...

Keyword(s):

Family Physicians ◽

Population Based ◽

People Living With Hiv ◽

Population Based Study ◽

Living With Hiv

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Cohort profile: Development and profile of a population-based, retrospective cohort of diagnosed people living with HIV in Ontario, Canada (Ontario HIV Laboratory Cohort)

BMJ Open ◽

10.1136/bmjopen-2018-027325 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027325

Author(s):

Juan Liu ◽

James Wilton ◽

Ashleigh Sullivan ◽

Alex Marchand-Austin ◽

Beth Rachlis ◽

...

Keyword(s):

Diagnostic Tests ◽

Retrospective Cohort ◽

Laboratory Data ◽

Population Based ◽

Hiv Care ◽

Hiv Positive ◽

People Living With Hiv ◽

Laboratory Test Results ◽

Living With Hiv

PurposePopulation-based cohorts of diagnosed people living with HIV (PLWH) are limited worldwide. In Ontario, linked HIV diagnostic and viral load (VL) test databases are centralised and contain laboratory data commonly used to measure engagement in HIV care. We used these linked databases to create a population-based, retrospective cohort of diagnosed PLWH in Ontario, Canada.ParticipantsA datamart was created by integrating diagnostic and VL databases and linking records at the individual level. These databases contain information on laboratory test results and sociodemographic/clinical information collected on requisition/surveillance forms. Datamart individuals enter our cohort with the first record of a nominal HIV-positive diagnostic test (1985–2015) or VL test (1996–2015), and remain unless administratively lost to follow-up (LTFU; no VL test for >2 years and no VL test in later years). Non-nominal diagnostic tests are excluded as they lack identifying information to permit linkage to other tests. However, individuals diagnosed non-nominally are included in the cohort with record of a VL test. The LTFU rule is applied to indirectly censor for death/out-migration.Findings to dateAs of the end of 2015, the datamart contained 40 372 HIV-positive diagnostic tests and 23 851 individuals with ≥1 VL test. Almost half (46.3%) of the diagnostic tests were non-nominal and excluded, although this was lower (~15%) in recent years. Overall, 29 587 individuals have entered the cohort—contributing 229 302 person-years of follow-up since 1996. Between 2000 and 2015, the number of diagnosed PLWH (cohort individuals not LTFU) increased from 8859 to 16 110, and the percent who were aged ≥45 years increased from 29.1% to 62.6%. The percent of diagnosed PLWH who were virally suppressed (<200 copies/mL) increased from 40.7% in 2000 to 79.5% in 2015.Future plansWe plan to conduct further analyses of HIV care engagement and link to administrative databases with information on death, migration, physician billing claims and prescriptions. Linkage to other data sources will address cohort limitations and expand research opportunities.

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