Evolution of mortality, retention and loss to follow up of HIV infected subjects followed in a special clinic

• Published in: Revista medíca de Chile Vol. 146; no. 3; p. 290
• Main Authors: Cortés, Claudia P, Lizana, Danae, Northland, Rebeca, Wolff R, Marcelo
• Format: Journal Article
• Language: Spanish
• Published: Chile 01.03.2018
• Subjects: Adult; Anti-Retroviral Agents - administration & dosage; Chile - epidemiology; Follow-Up Studies; HIV Infections - drug therapy; HIV Infections - mortality; Humans; National Health Programs; Refusal to Treat - statistics & numerical data; Retrospective Studies
• ISSN: 0717-6163; 0717-6163
• DOI: 10.4067/s0034-98872018000300290

The HIV epidemic reached Chile in late 1980s and as an early response, AIDS care centers were organized. Fundación Arriarán (FA) was the first center. Free antiretroviral therapy (ART) was later provided with progressive coverage and complexity over the years. To quantify evolution of mortality, retention and loss to follow up (LTFU) over 25 years according to different periods of access to ART, from no availability to full coverage with current drugs at FA center. Retrospective analysis of FA database of 5,080 adults admitted between 1990 and 2014. The sample was distributed in 7 groups: A: no ART (1990-92), B: monotherapy, C: dual therapy, D: dual/triple ART, E: early triple therapy with incomplete coverage, F same as E but with complete coverage and G: contemporary ART (2008-14). Mortality, retention and LTFU were evaluated at 1, 3, 5, 7 and 10 years and at 31/12/2015. Mortality varied from 40% to 2%, and 62% to 7% at 1 and 5 years, for groups A and G respectively; from 71% to 16% at 10 years for groups A and E, respectively. Retention at 5 years were 28%, 23%, 39%, 62%, 75%, 75% and 77% for groups A to G, respectively. LTFU was 10%, 19%, 15%, 17%, 9% 12% and 10% at 5 years for same groups, respectively. At 12/31/2015 22% of patients had died, 11% were LTFU, 60% were retained in care and 6% had been transferred. There is a marked reduction in mortality and increase in retention of HIV patients' concomitant to expanded access to modern therapy, although LTFU remains a problem.