Objectives
We aimed to study the incidence rate, predictors and outcomes of HIV care interruption (HCI) in
Belgium.
Methods
We analysed data for adult patients with at least two HIV care records in the Belgian HIV cohort
between 1 January 2007 and 31 December 2016. An HCI episode was defined as 1 year without an
HIV care record. The HCI incidence rate was analysed using Poisson regression, return to HIV care
using a cumulative incidence function with death as a competing risk, and viral load (VL) status
upon return to HIV care using logistic regression.
Results
We included 16 066 patients accounting for 78 625 person-years of follow-up. The incidence rate
of HCI was 5.3/100 person-years [95% confidence interval (CI) 5.1 5.4/100 person-years]. The –
incidence of return to HIV care after HCI was estimated at 77.5% (95% CI 75.7 79.2%). Of those –
who returned to care, 43.7% had a VL ≤ 200 HIV-1 RNA copies/mL, suggesting care abroad or
suboptimal care (without an HIV-related care record) in Belgium during the HCI, and 56.3%
returned without controlled VL and were therefore considered as having experienced a real gap in
HIV care; they represented 2.3/100 person-years of follow-up. Factors individually associated with
HCI were no antiretroviral therapy (ART) uptake, lower age, injecting drug use, non-Belgian
nationality, male gender, not being a man who has sex with men, a shorter time since HIV
diagnosis, no high blood pressure and CD4 count < 350 cells/μL.
Conclusions
This study highlights the need to investigate return to care and viral status at return, to better
understand HCI. Identified predictors can help health care workers to target patients at higher risk
of HCI for awareness and support.
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