One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients

Objective. To determine whether adherence to clinic visits early after initiation of highly active antiretroviral therapy (HAART) is predictive of long-term clinical outcome. Design. Observational cohort study. Setting. A tertiary referral hospital. Subjects. A total of 387 adult HIV patients who were followed for at least 1 year after initiation of HAART between January 1998 and December 2004. Main outcome measurements. The effect of 1-year adherence to clinic visits on the occurrence of new AIDS-defining illness or death was assessed using Kaplan-Meier survival estimates, and hazard ratios were estimated using Cox proportional hazards regression model. Results. Multivariate analysis revealed that advanced clinical stage, fewer new drugs in HAART, and longer total elapsed time without clinical visits for 1 year after HAART were all significant risk factors for the occurrence of new AIDS-defining illnesses or death. Compared with no missed visits, the hazard ratio adjusted by clinical stage and number of new drugs in HAART was 2.87 (95% confidence interval [CI], 1.34-6.16, P = 0.007) for one missed appointment, 4.37 (95% CI: 1.74-10.98, P = 0.002) for two, and 8.19 (95% CI: 2.95-22.78, P < 0.001) for three or more. Conclusion. Adherence to clinic visits early after initiation of HAART is an independent predictor for long-term clinical progression in HIV patients.