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.