May 17, 2007

Regular Healthcare Visits a Key to Survival
(AIDSmeds.com)

HIV-positive people who do not consult with their healthcare providers on a regular basis do not live as long as those who do, according to a new study published in the June 1 issue of Clinical Infectious Diseases. The new data, reported by investigators at Baylor College of Medicine and Veterans Affairs in Houston, indicate that doctors visits, every three months, are a key to HIV survival.

In an era when highly active therapy directed against HIV is keeping people alive, understanding the value of regular medical care is crucial," said Thomas Giordano, MD, Assistant Professor of Medicine of Infectious Diseases at Baylor and a lead author of the report.

"We know that adherence to medications is critically important," said Dr. Giordano. "Patients who have trouble taking their medicines regularly will do less well. But what about those people who aren't even seeing a doctor regularly? Before this study, we had only a vague understanding of the magnitude of the problem, and we certainly didn't know whether it affected survival."

While HIV is now a chronic disease, it is one that typically strikes at a relatively young age. That makes the population different from those who have high blood pressure or adult-onset diabetes.

"These patients often have a lot of other things going on. They are young. Often, they face challenges of substance abuse, mental health problems, and financial issues. Now they have to stay in care the rest of their lives, which may be 20, 30, 40 or more years."

The study, carried out in the Veterans Affairs population, concluded that regular consultation with a healthcare provider is independently associated with longer survival. Studying those in the VA population eliminated the issue of ability to pay for care, enabling him and his colleagues to look at care alone.

Dr. Giordano's group followed 2,619 HIV-positive men for more than four years. Most were diagnosed between 1997 and 1998 at a VA hospital or clinic and began treatment after Jan. 1, 1997.

The study called for dividing the men into four groups based on the number of quarters (three-month intervals) in the first year after starting treatment that they visited their healthcare provider. Sixty-four percent of them had at least one visit in all four quarters, 18% in three of four quarters, 11% in two of four quarters, and 6% in only one quarter. The researchers then looked at how long the patients survived after that first year.

Sixteen percent of the patients died. Those who had poorer retention in care or visited their physicians less during the year after starting treatment had a greater risk of dying than those who saw the physicians at least once every three months. Patients with a visit in only one quarter had nearly twice the risk of dying compared to patients with visits in all four quarters.

"The next step is to figure out how to get them to stay in care," said Dr. Giordano.

An accompanying editorial, written by Laura Cheever, MD, of the U.S. Department of Health and Human Services, concurs with Dr. Giordano and the conclusion of the Baylor study.

Dr. Cheever writes: "To continue to provide excellent health care services and reduce HIV-related health disparities – thereby diminishing the HIV infection epidemic – we must use our limited resources to develop, study, and adopt innovative strategies to engage and retain HIV-infected patients in care."

Source:

Cheever LW. Engaging HIV-infected patients in care: their lives depend on it. Clin Infect Dis 44:1500-2, 2007.

Giordano TP, Gifford AL, White AC, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis 44:1493-9, 2007.

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