Early Retention in Care Neither Mediates Nor Modifies the Effect of Sex and Sexual Mode of HIV Acquisition on HIV Survival in the Americas

Sterling, Timothy R.; Luz, Paula M.; Shepherd, Bryan E.; Rebeiro, Peter F.; Padgett, Denis; Castilho, Jessica L.; Cortes, Claudia P.; Caro-Vega, Yanink; Coelho, Lara; Cesar, Carina; McGowan, Catherine C.; Veloso, Valdiléa G.; Grinsztejn, Beatriz; Mejía Cordero, Fernando Alonso

dc.contributor.author	Coelho, Lara
dc.contributor.author	Rebeiro, Peter F.
dc.contributor.author	Castilho, Jessica L.
dc.contributor.author	Caro-Vega, Yanink
dc.contributor.author	Mejía Cordero, Fernando Alonso
dc.contributor.author	Cesar, Carina
dc.contributor.author	Cortes, Claudia P.
dc.contributor.author	Padgett, Denis
dc.contributor.author	McGowan, Catherine C.
dc.contributor.author	Veloso, Valdiléa G.
dc.contributor.author	Sterling, Timothy R.
dc.contributor.author	Grinsztejn, Beatriz
dc.contributor.author	Shepherd, Bryan E.
dc.contributor.author	Luz, Paula M.
dc.date.accessioned	2018-10-10T23:27:54Z
dc.date.available	2018-10-10T23:27:54Z
dc.date.issued	2018
dc.identifier.uri	https://hdl.handle.net/20.500.12866/3879
dc.description.abstract	Early retention in care, sex, and sexual mode of HIV acquisition has been associated with mortality risk among persons living with HIV (PLWH). We assessed whether early retention in care mediates or modifies the association between mortality and sex and sexual mode of HIV acquisition among PLWH on antiretroviral therapy (ART) in the Americas. ART-naïve, adult PLWH (≥18 years) enrolling at Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and Vanderbilt Comprehensive Care Clinic sites 2000–2015, starting ART, and with ≥1 visit after ART-start were included. Early retention in care was defined as ≥2 HIV care visits/labs ≥90 days apart in the first year of ART. Cox models assessed the association between early retention in care, sex, and sexual mode of HIV acquisition [i.e., women, heterosexual men and men who have sex with men (MSM)], and mortality. Associations were estimated separately by site and pooled. Among 11,721 included PLWH (median follow-up, 4.3 years; interquartile range, 2.0–7.6), 647 died (rate = 10.9/1000 person-years) and 1985 were lost to follow-up (rate = 33.6/1000 person-years). After adjustment for confounders, early retention in care was associated with lower mortality during subsequent years (pooled hazard ratio = 0.47; 95% confidence interval = 0.39–0.57). MSM had lower and heterosexual men had comparable mortality risk to women; risks were similar when adjusting for early retention in care. Additionally, no evidence of an interaction between early retention in care and sex and sexual mode of HIV acquisition on mortality was observed (p > 0.05). Early retention in care substantially reduced mortality but does not mediate or modify the association between sex and sexual mode of HIV acquisition and mortality in our population.	en_US
dc.language.iso	eng
dc.publisher	Mary Ann Liebert
dc.relation.ispartofseries	AIDS Patient Care and STDs
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Retention in care	en_US
dc.subject	Mortality	en_US
dc.subject	Sex Disparities	en_US
dc.subject	HIV	en_US
dc.subject	Americas	en_US
dc.title	Early Retention in Care Neither Mediates Nor Modifies the Effect of Sex and Sexual Mode of HIV Acquisition on HIV Survival in the Americas	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1089/apc.2018.0028
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.08
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.05
dc.relation.issn	1557-7449