Many HIV-positive people cycle in and out of care for the virus, signaling a need for ongoing measures to keep them integrated into the health care system and taking antiretrovirals (ARVs) consistently. Publishing their findings in the journal AIDS, researchers conducted a retrospective cohort study of 6,152 HIV-positive Canadians who started ARVs for the first time between 1996 and 2012 in British Columbia.

A total of 81.2 percent of the cohort was male, 40.6 percent were injection drug users (IDUs), and 42.8 percent started treatment with fewer than 200 CD4 cells.

Twenty-nine percent of the cohort stayed on ARVs continuously after beginning treatment. The cohort spent a median 6.8 months continuously on ARVs. They spent a median 1.9 months off ARVs during treatment gaps.

Among those who had multiple gaps in treatment, the periods spent on treatment tended to shorten over time, while the duration of the gaps remained constant. For those who started ARVs later in the study, treatment periods were longer and gap periods were shorter. Specifically, the periods spent on treatment were 27 percent longer and the gap periods were 59 percent shorter for those who started ARVs after 2008 compared with those who started between 1996 and 1999. The researchers speculated that these improving statistics were probably attributable to the lower pill burden and decreased side effects of newer ARVs.

Being younger, being at an earlier stage of HIV disease, and using injection drugs were all linked with shorter periods spent on ARVs and longer periods spent off of them.

The investigators found that more frequent contact with clinicians as well as being in HIV care were linked with more time spent on ARVs. They concluded, “Metrics to monitor [ARV] retention, dropout, and reentry should be prioritized for HIV surveillance. Clinical strategies and public health policies are urgently needed to improve [ARV] retention, particularly among those at earlier stages of disease progression, the young, and people who inject drugs.”

To read the study abstract, click here.