Care interruptions and mortality among adults in Europe and North America: a collaborative analysis of cohort studies. AIDS
For people with HIV, continuous antiretroviral therapy (ART) has dramatically reduced HIV-related illness and death. However, interruptions in HIV care and treatment remain a significant challenge. In a comprehensive study published in AIDS, Trickey et al. examined how breaks in care affect survival among people with HIV in Europe and North America.
The researchers analyzed data from 89’197 individuals across 18 cohorts in the Antiretroviral Therapy Cohort Collaboration (ART-CC). The study included people who started ART between 2004 and 2019, defining care interruptions as gaps in clinical contact of one year or longer, followed by a return to care.
Several key factors increased the likelihood of care disruptions: younger age (16–24 years), having a history of injection drug use, and acquiring HIV through heterosexual contact. The consequences of these interruptions proved substantial. When people resumed ART after a break in care, their risk of death increased by 72% compared to those starting ART for the first time (adjusted hazard ratio 1.72, 95% CI 1.57-1.88), resulting in 24 deaths per 1000 person-years. More concerning still, this risk grew with repeated interruptions, more than doubling after a second break in care. The study revealed that these deaths weren’t limited to AIDS-related causes like opportunistic infections, but also included non-AIDS conditions such as cardiovascular disease and non-hepatitis cancers, highlighting how care interruptions affect overall health.
These findings underscore the critical importance of maintaining continuous HIV care, particularly for vulnerable groups such as young people with HIV and those who inject drugs. This research, conducted within the ART-CC framework, provides compelling evidence to inform public health strategies and policies aimed at keeping people engaged in life-saving HIV care.