Late re-engagement into HIV care among adults in the swiss HIV cohort study
Antiretroviral therapy (ART) has significantly improved both life expectancy and quality of life for people living with HIV. However, maintaining continuous use of ART can be challenging, and some individuals disengage from healthcare over time. In a recent study published in JAIDS, Haas et al. examined retention in care among people with HIV in the Swiss HIV Cohort Study and described the characteristics of patients at the time of re-engagement.
The study included 14’864 participants, of whom 2768 (18.6 %) experienced an interruption in care. Of these, 1489 (53.8 %) later re-engaged with care during a median follow-up period of 10.2 years. Retention in care declined from 91.2 % (95 % CI 90.7–91.7) at 2 years to 78.3 % (95 % CI 77.5–79.1) at 10 years after initiating ART.
After excluding individuals without available viral load measurements or ART information, 1384 participants who re-engaged in care were analyzed. Among them, 862 (62.3 %) had interrupted ART. Compared to those who maintained continuous care, patients who interrupted care were more likely to be younger, female, of African origin, have acquired HIV through injection drug use, and have lower levels of education. Among those who interrupted ART during their gap in care, more than half returned with a CD4 cell count below 350 cells/µL or with a new AIDS-defining condition.
In summary, while care interruptions were relatively uncommon in Switzerland, most individuals who discontinued ART returned to care with advanced immunosuppression or AIDS-related conditions. These findings highlight the importance of targeted strategies to identify, support, and re-engage people living with HIV who are at risk of treatment interruption, in order to prevent disease progression and improve long-term outcomes.