2026-04-29T00:59:52Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/254352025-12-18T13:01:29Zcom_20.500.12105_2052com_20.500.12105_2051col_20.500.12105_19608

00925njm 22002777a 4500 dc Trickey, Adam author Zhang, Lei author Rentsch, Christopher T author Pantazis, Nikos author Izquierdo Miguel, Rebeca author Antinori, Andrea author Leierer, Gisela author Burkholder, Greer author Cavassini, Matthias author Palacio-Vieira, Jorge author Gill, M John author Teira, Ramon author Stephan, Christoph author Obel, Niels author Vehreschild, Jörg-Janne author Sterling, Timothy R author van der Valk, Marc author Bonnet, Fabrice author Crane, Heidi M author Silverberg, Michael J author Ingle, Suzanne M author Sterne, Jonathan A C author Antiretroviral Therapy Cohort Collaboration (ART-CC) author 2024-08-01 Objective: Interruptions in care of people with HIV (PWH) on antiretroviral therapy (ART) are associated with adverse outcomes, but most studies have relied on composite outcomes. We investigated whether mortality risk following care interruptions differed from mortality risk after first starting ART. Design: Collaboration of 18 European and North American HIV observational cohort studies of adults with HIV starting ART between 2004 and 2019. Methods: Care interruptions were defined as gaps in contact of ≥365 days, with a subsequent return to care (distinct from loss to follow-up), or ≥270 days and ≥545 days in sensitivity analyses. Follow-up time was allocated to no/preinterruption or postinterruption follow-up groups. We used Cox regression to compare hazards of mortality between care interruption groups, adjusting for time-updated demographic and clinical characteristics and biomarkers upon ART initiation or re-initiation of care. Results: Of 89 197 PWH, 83.4% were male and median age at ART start was 39 years [interquartile range (IQR): 31-48)]. 8654 PWH (9.7%) had ≥1 care interruption; 10 913 episodes of follow-up following a care interruption were included. There were 6104 deaths in 536 334 person-years, a crude mortality rate of 11.4 [95% confidence interval (CI): 11.1-11.7] per 1000 person-years. The adjusted mortality hazard ratio (HR) for the postinterruption group was 1.72 (95% CI: 1.57-1.88) compared with the no/preinterruption group. Results were robust to sensitivity analyses assuming ≥270-day (HR 1.49, 95% CI: 1.40-1.60) and ≥545-day (HR 1.67, 95% CI: 1.48-1.88) interruptions. Conclusions: Mortality was higher among PWH reinitiating care following an interruption, compared with when PWH initially start ART, indicating the importance of uninterrupted care. AIDS 2024 Aug 1;38(10):1533-1542. 0269-9370 https://hdl.handle.net/20.500.12105/25435 38742863 10.1097/QAD.0000000000003924 1473-5571 AIDS (London, England) Adherence Antiretroviral therapy Mortality North America Treatment gap Western Europe Care interruptions and mortality among adults in Europe and North America