489. Mortality after Loss-from-HIV-Care (LFHC): Implications for Persons of Older Age, with Late Diagnoses, and Unsuppressed Viral Load at the Time of LFHC from a Pennsylvania HIV Clinic.
Session: Poster Abstract Session: HIV Care Continuum
Thursday, October 27, 2016
Room: Poster Hall
  • MUTHAMBI-et-al-2016-Death-after-LFHC-v5.pdf (1.1 MB)
  • Background: The occurrence and predictors of mortality after loss-from-HIV-care (LFHC) are not well elucidated, and were therefore assessed in this study.

    Methods: The retrospective cohort study included 389 persons >12 years of age at the time of LFHC from a Pennsylvania clinic during 2003-2012. Predictor characteristics were reviewed, and follow-up outcomes were ascertained through 2014 by way of record-linkage of clinic Careware™ data with disease registries, claims databases of publicly-funded state health insurance, and death registry. Multivariate logistic regression analyses were performed to determine the likelihood of death after LFHC, and how this varies by several predictors.

    Results: Approximately 25% of 389 persons studied were deceased, and all others were presumed alive. Multiple logistic regression analyses showed greater likelihood of death for those whose status at the time of LFHC was: a) 45-55 years old (adjusted odds ratio/aOR=3.41;95%Confidence-Interval,CI=1.41—8.25) compared to those 13-34, and even greater for those >=55 (aOR=5.51;95%CI=2.11-14.41); b) late diagnosed(HIV stage-3/AIDS) with unsuppressed viral load/VL (aOR=4.91;95%CI=1.14-21.23) compared to persons diagnosed before HIV stage-3 with suppressed VL, who were comparable to others. The likelihood of death was lower for: a) persons whose probable mode of HIV acquisition was ‘not documented’, other than heterosexual contact or males who have sex with men (aOR=0.28;95%CI=0.10-0.80) compared to those with a history of injection drug use, b) a mostly Latino/Hispanic group including a few others of unknown race/ethnicity (aOR=0.42;95%CI=0.19-0.91), compared to Caucasians/whites, who were comparable to African-Americans/blacks, and c) those with no documented re-engagement/not trackable after LFHC (aOR=0.51;95%CI=0.28-0.92), compared to persons with documented re-engagement at other clinics. There were no differences by several other characteristics.

    Conclusion: The higher occurrence of death associated with older age and late diagnoses with unsuppressed VL at the time of LFHC may indicate a frailty effect suggesting a need for timely screening and closer case management support to address retention-in-care and viral suppression needs of such vulnerable populations. Fewer deaths among those not re-engaged require further study, including out-migration.

    Ekezie Francis, MD1, Benjamin Muthambi, DrPH, MPH2, Nathan Geyer, MS, PhD(c)3, Paul Colson, PhD4, John Zurlo, MD5 and Tonya Crook, MD, MS, DTM&H5, (1)Medicine/Infectious Diseases, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, (2)The Hase Collaboration, Institutes of Epidemiology & Public Health/iHASE (an iOATPRP affiliate), Harrisburg, PA, (3)Public Health Sciences/Epidemiology, Penn State College of Medicine, HERSHEY, PA, (4)Epidemiology/ICAP, Columbia University Mailman School of Public Health, New York, NY, (5)Medicine/Infectious Diseases, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA


    E. Francis, None

    B. Muthambi, None

    N. Geyer, None

    P. Colson, None

    J. Zurlo, None

    T. Crook, None

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