Buddy Up to Your Doc

People with HIV who drop out of care do not live as long as those who remain under a physician's treatment, say researchers from the U.S. Department of Veterans Affairs and Baylor College of Medicine in a report published in the June 1 issue of Clinical Infectious Diseases. 'In an era when highly active therapy directed against HIV is keeping people alive, understanding the value of regular medical care is crucial,' says Thomas Giordano, an assistant professor of medicine and infectious diseases at Baylor and the lead author of the report. 'We know that adherence to medications is critically important. 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, lifelong disease, it typically strikes at a relatively young age. That makes the population different from one that has high blood pressure or adult-onset diabetes. 'These patients often have a lot of other things going on,' Giordano says. '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.' Giordano's study, carried out in the VA population, determined that staying in care made a difference in longevity. 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. They studied 2,619 men with HIV for more than four years. Most were diagnosed in 1997 or 1998 at a VA hospital or clinic and began treatment after January 1, 1997. Researchers divided the men into four groups, based on the number of quarters in the first year after starting treatment that they visited their HIV physicians or health care 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 the physicians less during the year after starting treatment had a greater risk of dying than those who saw the physicians at least once each quarter. Patients with visits 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,' Giordano says. He plans to look for ways to intervene in this process. He is now studying a group of people who are newly diagnosed with HIV in Houston to evaluate the effects of socioeconomics, knowledge about the disease, and other factors on retention in care. --Benjamin Ryan