Increased mortality and morbidity risk in people with early HIV care interruption in Spain, 2004-2023.

Abstract

Objective: We assessed the association between early HIV medical care interruption (MCI) and the development of AIDS-defining events (ADEs), serious non-AIDS events (SNAEs), and death among people with HIV (PWH) from the CoRIS cohort.

Design: We included antiretroviral-naive individuals aged at least 18 years at enrollment, recruited between 1 January 2004 and 30 May 2021, and followed-up until 30 November 2023.

Methods: Early MCI was defined as a time interval over 15 months between two consecutive visits, where the first of these visits occurred within the first 15 months of enrollment. We used Poisson regression models to assess the association between early MCI and the outcomes.

Results: Of 14 594 individuals, 1067 (7.3%) experienced an early MCI. Individuals with early MCI showed higher risk of developing ADEs (adjusted incidence rate ratio, aIRR: 2.92; 95% confidence interval (CI) 2.24-3.81) than those who did not. Early MCI was associated with a higher risk of overall mortality (2.15; 95% CI 1.75-2.64), AIDS-related deaths (3.54; 95% CI 2.35-5.44) and deaths due to liver diseases (2.44; 95% CI 1.19-4.98), but was not with mortality due to non-AIDS-defining malignancies (1.20; 95% CI 0.58-2.49). The primary underlying causes of death among individuals with early MCI were AIDS-related deaths (17%), non-AIDS-defining malignancies (11.7%) and liver diseases (10.6%).

Conclusion: Early MCI was associated with an increased rate of ADEs and death, underscoring the need to design and implement public health strategies that bolster retention in care among PWH.