The HIV/AIDS mailbox…
Doctors warn…
Last Monday, we examined the impact of Poor Nutrition/Treatment interruptions on HIV/AIDS, and the point was made that “stopping HIV antiretroviral therapy (ART) is deadly.”

In order to avoid such unwelcome consequences, PLHIV were cautioned to ensure they take their medication “exactly as prescribed by their doctors or clinician,” and that if having problems, to see their doctors as soon as possible.

This week, as a follow-up, and to give our readers an impacting snapshot into the implications of treatment interruption, the HIV/AIDS Mailbox wishes to share with you a well-researched and documented report, presented by Michael Carter of NAM (Aidsmap News).

An editor at NAM since 2002, Carter edits the Aidsmap news service, and is NAM’s Patient Information Editor with responsibility for the award-winning range of booklets.

Here, Carter tells of the consequences of non-adherence, or what he refers to as “being lost to follow-up” by persons on therapy:

HIV-POSITIVE patients who return to care after being lost to follow-up are five times more likely to die in the short-term than patients who remain in HIV care continuously, French investigators report in the online edition of AIDS.

“Increased efforts are needed to reduce loss to follow-up and encourage those patients who no longer attend clinic to return to care,” recommend the authors.

Thanks to effective antiretroviral treatment, the prognosis of many HIV-positive individuals is now near normal. However, despite the benefits of treatment and care, some patients stop attending their HIV clinic.

Investigators in northern France looked at the characteristics and outcome of patients who were lost to follow-up for at least twelve months, and who subsequently returned to HIV care.

A total of 1007 patients received HIV care at five treatment centres in the Nord Pas-de-Calais region between 1997 and 2006. Of these patients, 135 (13%) were lost to follow-up. A total of 74 (55%) of these individuals subsequently returned to their HIV clinic.

There were some significant differences between patients lost to follow-up and those remaining in HIV care. Those lost to follow-up were younger (median, 31 years Vs 35 years, p < 0.01), more likely to be injecting drug users (12% Vs 3%, p < 0.0001), less likely to have an AIDS-defining illness when they first entered care (11% Vs 20%, p = 0.01), and had a higher CD4 cell count at the time of their enrolment into the clinic cohort (369 cells/mm3 Vs 334 cells/mm3).

The 74 patients returning to care did so after a median interval of 19 months. Their median CD4 cell count was significantly lower at the time they returned to care (305 cells/mm3) than at the point they were lost to follow-up (401 cells/mm3, p < 0.001).

Upon return, 33 patients (45%) had a CD4 cell count below 200 cells/mm3 and 20 (27%) had an AIDS-defining illness. A total of 14% of individuals lost to follow-up were hospitalised within six months of their return to care, the median stay in hospital being 23 days. The mortality rate amongst patients returning to care was 8% compared to 5% amongst individuals who attended clinic regularly.

When the investigators conducted statistical analysis that controlled for CD4 cell count and AIDS-defining events on first enrolment, they found that individuals returning after being lost to follow-up were over five times more likely to die than patients who remained in HIV care (5.14, 95% CI, 2.11 to 12.54).

“Similar to patients who present to care very late, these patients [lost to follow-up] are more likely to have one or more AIDS-defining illness, to be hospitalised as a result of an AIDS-defining event, and to die,” comment the investigators.

Moreover, the investigators suggest that “lost to follow-up may also increase the risk of HIV transmission, as patients who interrupt combination antiretroviral therapy cannot benefit from the favourable effect of antiretroviral drugs on infectiousness.”

Meanwhile, together with NAM, we wish to remind you our readers that:

1)Taking HIV treatment has benefits. It can mean a longer, healthier life. Even though there’s no cure for HIV, doctors are now hopeful that you can live a normal length of time, if you take a combination of anti-HIV drugs.

2)The goal of HIV treatment is an ‘undetectable viral load’ – extremely low levels of HIV in the blood and a better quality of life. You need to take all your anti-HIV drugs as instructed. This means:

• Taking all your doses of medicine at the right time

• Taking your medicine in the right way (for example, with or without food) and

• Making sure that you don’t take other medicines or drugs that affect your treatment.

3)HIV treatment is there to protect and improve your health

However, anti-HIV drugs can cause side-effects. If you have side-effects, make sure that you tell your doctor as there’s a good chance you’ll be able to do something about them.

If you have further questions, or would like to share experiences with us, please contact us at waronhiv@yahoo.com, or send your letters to: HIV/AIDS Mailbox, Guyana Chronicle, Lama Avenue, Bel Air Park, Georgetown.