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HIV survival improves if patients stay in care

HOUSTON (May 11, 2007) – People with HIV who drop out of care do not live as long as those who remain under a doctor's treatment, said Baylor College of Medicine and Veterans Affairs researchers in a report published in the June 1 issue of Clinical Infectious Diseases and available on line.

"In an era when highly active therapy directed against HIV (the human immunodeficiency virus that causes AIDS) is keeping people alive, understanding the value of regular medical care is crucial," said Dr. Thomas Giordano, assistant professor of medicine – infectious diseases at BCM and lead author of the report.

"We know that adherence to medications is critically important," said Giordano. "Patients who have trouble taking their medicines regularly will do less well. But what about those people who aren't even seeing a doctor regularly" Before this study, we had only a vague understanding of the magnitude of the problem, and we certainly didn't know whether it affected survival."

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While HIV is now a chronic or lifelong disease, it is one that typically strikes at a relatively young age. That makes the population different from those who have high blood pressure or adult-onset diabetes.

"These patients often have a lot of other things going on. They are young. Often, they face challenges of substance abuse, mental health problems and financial issues. Now they have to stay in care the rest of their lives, which may be 20, 30, 40 or more years."

Giordano's study, carried out in the Veterans Affairs population, determined that staying in care made a difference to longevity. Studying those in the VA population eliminated the issue of ability to pay for care, enabling him and his colleagues to look at care alone.

Giordano and his colleagues looked at 2,619 men with HIV for more than four years. Most were diagnosed between 1997-1998 at a VA hospital or clinic and began treatment after Jan. 1, 1997.

Researchers divided the men into four groups based on the number of quarters in the first year after starting treatment that they visited their HIV physicians or health care provider. Sixty-four percent of them had at least one visit in all four quarters, 18 percent in three of four quarters, 11 percent in two of four quarters and 6 percent in only one quarter. The researchers then looked at how long the patients survived after that first year.

Sixteen percent of the patients died. Those who had poorer retention in care or visited the physicians less during the year after starting treatment had a greater risk of dying than those who saw the physicians at least once each quarter. Patients with visits in one quarter had nearly twice the risk of dying compared to patients with visits in all four quarters.

"The next step is to figure out how to get them to stay in care," said Giordano. He plans to look for ways to intervene in this process. He is now studying a group of people who are newly diagnosed with HIV in Houston to evaluate the effects of knowledge about the disease socioeconomics, and other factors on retention in care.

Others who took part in this work include Drs. A. Clinton White, Jr., Maria E. Suarez-Almazor, Christine Hartman, and Robert O. Morgan of BCM and the Michael E. DeBakey Veterans Affairs Medical Center in Houston; Allen L. Gifford, of the Center for Health Quality, Outcomes, and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MA, and Boston University; Linda Rabeneck of the University of Toronto and Toronto Sunnybrook Regional Cancer Centre in Canada, and Lisa I. Backus, and Larry A. Mole of the Center for Quality Management in Public Health, Department of Veterans Affairs, Palo Alto, Ca. White is now with The University of Texas Medical Branch in Galveston and Suarez-Almazor is with The UT M.D. Anderson Cancer Center in Houston.

Funding for this work came from the National Institutes of Mental Health and the Health Services Research and Development Service, Office of Research and Development, U.S. Department of Veterans Affairs.