Compound retention in care and all-cause mortality among persons living with human immunodeficiency virus

Emma Sophia Kay, D. Scott Batey, Andrew O. Westfall, Katerina Christopoulos, Stephen R. Cole, Elvin H. Geng, W. Christopher Mathews, Richard D. Moore, Michael J. Mugavero

Research output: Contribution to journalArticlepeer-review


Background. To obtain optimal health outcomes, persons living with human immunodeficiency virus (HIV) must be retained in clinical care. We examined the relationships between 4 possible combinations of 2 separate retention measures (missed visits and the Institute of Medicine [IOM] indicator) and all-cause mortality. Methods. The sample included 4162 antiretroviral therapy (ART)-naive patients who started ART between January 2000 and July 2010 at any of 5 US sites of the Center for AIDS Research Network of Integrated Clinical Systems. The independent variable of interest was retention, captured over the 12-month period after the initiation of ART. The study outcome, all-cause mortality 1 year after ART initiation, was determined by querying the Social Security Death Index or the National Death Index. We evaluated the associations of the 4 categories of retention with all-cause mortality, using the Cox proportional hazards models. Results. Ten percent of patients did not meet retention standards for either measure (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.59-3.21). Patients retained by the IOM but not the missed-visits measure (42%) had a higher HR for mortality (1.72; 95% CI, 1.33-2.21) than patients retained by both measures (41%). Patients retained by the missed-visits but not the IOM measure (6%) had the same mortality hazards as patients retained by both measures (HR, 1.01; 95% CI, .54-1.87). Conclusions. Missed visits within the first 12 months of ART initiation are a major risk factor for subsequent death. Incorporating missed visits in clinical and public health retention and viral suppression programming is advised.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Issue number4
StatePublished - Apr 2019


  • Hazard ratio
  • Mortality hazards
  • Retention in care

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology


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