Predictors of retention in care for HIV-infected patients: data from San Martino Hospital cohort in Genoa

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Background: Retention in care (RC) is a key feature of the cascade of continuum of care that moves from HIV testing to linkage to care, engagement in care and RC. RC play an important role in achieving and maintaining therapeutic success and is crucial for reduction of HIV transmission. The aim of this study was to evaluate the rate of RC in the Infectious Disease unit of San Martino Hospital, in Genoa and to identify predictors associated with failed RC. Methods: All new HIV tested and diagnosed subjects were consecutively enrolled from 01/01/2008 to 01/08/2014. Follow-up period was censored at 01 February 2015. Demographics, immune-virological status, co-infection with HCV and HBV and therapeutic data were collected at baseline and at the time of last observation. Failed RC was defined as lack of laboratory data, clinical visits and drug dispensation for more than 6 months. Causes of failed RC were recorded, if available. Total and partial frequencies were calculated for categorical variables, while media and median were computed for continuous variables .The relationship between the RC and the parameters taken into account was examined with a univariate analysis, using Chi-squared test for dichotomous outcome variables and the Student's T test for the continuous outcome variables to evaluate the P values. The level of significance was set at P <0.05. Results: we enrolled 209 patients (mean age 45.1 years). Males were 152 (73%), Italian 169 (81%) with mean length of disease of 43.8 months. Co-infection HBV/HIV and HCV/HIV were present in 7 (3%) and 30 (14%) patients respectively. At baseline mean lymphocyte T cell CD4+ was 267/mmc with 46% of subjects with CD4+ <200/mmc of which 42% <50/mmc. HIV-RNA was over 100,000 copies for 38% of patients. Antiretroviral therapy (cART) was prescribed for 194 patients (93%). The rate of RC was 82%. Among patients who failed retaining in care 9 (24%) died and 6 (16%) moved to other medical centers. Differences between patients retained in care and lost at follow up are showed in table 1. Failed RC was associated with foreign origin (p=0.016), HBV/HIV co-infection (p=0.005), CD4+ count <200/mmc and HIV-RNA greater than 50 copies/ml at observation time (p<0.0001 respectively) and being not treated for HIV-infection (p<0.0001). Conclusions: The rate of RC in San Martino cohort is similar than compared to those estimated for US and Italian cohorts (81% and 85%). Foreign origin and lack of prescription of initial cART are the key factors in RC.

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