February 1, 2008
In the current study, the authors observe that while a significant proportion of HIV/AIDS patients receiving antiretroviral therapy (ART) in resource-limited settings are lost to follow-up, the causes of this are not well understood. The team conducted a retrospective inquiry of patients who, between April 2004 and June 2005, discontinued ART offered through a public clinic in Johannesburg. Of 1,631 adult patients, 267 (16.4 percent) had discontinued follow-up for at least six weeks, and the researchers tabulated the causes for treatment disruption among 173 (64.8 percent) patients later traced.
Gender, ethnicity, and age were not predictive of treatment default. Rather, death accounted for 48 percent (n=83) of traced patients lost during ART. Characteristics associated with death included older age at ART initiation (P=0.022), lower baseline CD4 cell count (P=0.0073), higher baseline HIV RNA load (P=0.024), and loss of weight on ART (P=0.033). Of the 71 percent (n=59) of patients whose date of death was determined, 83 percent (n=49) died within 30 days of ART initiation. Frequent non-mortality-related reasons for dropping out included relocation or clinic transfer (25.4 percent) and hospitalization or illness (10.4 percent). Few reported financial strains or ART toxicity as reasons for stopping ART.
In this study, nearly one-sixth of patients were lost to follow-up over a 15-month period. "Early mortality was high, especially in those with profound immunosuppression," the authors concluded. "Improving access to care and streamlining patient tracking may improve ART outcomes."