Illicit drug use is a significant risk factor for loss to follow up in patients with HIV-1 infection at a large urban HIV clinic in Tokyo

• Published in: PloS one Vol. 8; no. 8; p. e72310
• Main Authors: Nishijima, Takeshi, Gatanaga, Hiroyuki, Komatsu, Hirokazu, Takano, Misao, Ogane, Miwa, Ikeda, Kazuko, Oka, Shinichi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.08.2013; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - virology; Adult; AIDS; Ambulatory Care Facilities - statistics & numerical data; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; CD4 antigen; Charts; Comorbidity; Drug abuse; Drug therapy; Drug use; Epidemiology; Female; Hazards; Health risks; Heroin; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; HIV-1; Human immunodeficiency virus; Humans; Incidence; Infections; Kaplan-Meier Estimate; Lost to Follow-Up; Male; Medical prognosis; Medical records; Medical research; Medically uninsured persons; Medicine; Mens health; Methamphetamine; Multivariate Analysis; Nurses; Patients; Prognosis; Proportional Hazards Models; Risk analysis; Risk Assessment - methods; Risk Assessment - statistics & numerical data; Risk Factors; Studies; Substance abuse treatment; Substance-Related Disorders - epidemiology; Tokyo - epidemiology; Tokyo; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0072310

Loss to follow up (LTFU) is an important prognostic factor in patients with HIV-1 infection. The impact of illicit drug use on LTFU of patients with HIV-1 infection is unknown in Japan. A single center observational study was conducted to elucidate the impact of illicit drug use on LTFU at a large HIV clinic in Tokyo. LTFU was defined as those who discontinued their visits to the clinic for at least 12 months and were not known to be under the care of other facilities or have died within 12 months of their last visit. Patients who first visited the clinic between January 2005 and August 2010 were enrolled. Information on illicit drug use was collected in a structured interview and medical charts. Comparison of the effects of illicit drug use and no use on LTFU was conducted by uni- and multi-variate Cox hazards models as the primary exposure. The study subjects were 1,208 patients, mostly Japanese men, of relatively young age, and infected through homosexual contact. A total of 111 patients (9.2%) were LTFU (incidence: 24.9 per 1,000 person-years). Among illicit drug users and non users, 55 (13.3%) and 56 (7.1%) patients, respectively, were LTFU, with incidence of 35.7 and 19.2 per 1,000 person-years, respectively. Uni- and multi-variate analyses showed that illicit drug use was a significant risk for LTFU (HR=1.860; 95% CI, 1.282-2.699; p=0.001) (adjusted HR=1.544; 95% CI, 1.028-2.318; p=0.036). Multivariate analysis also identified young age, high CD4 count, no antiretroviral therapy, and no health insurance as risk factors for LTFU. The incidence of LTFU among illicit drug users was almost twice higher than that among non users. Effective intervention for illicit drug use in this population is warranted to ensure proper treatment and prevent the spread of HIV.