Disengagement and reengagement of HIV continuum of care in a single center cohort in northern Italy

Figures & data

Figure 1 Flow chart of patients in the HIV cohort, linked to care and with loss to follow-up (LTFU).

Table 1 Characteristics of HIV patients with at least one visit between 2012 and 2018 (HIV cohort)

Characteristics
Total	3822
Age, yr, mean (range)	50.1 (17–75)
Female gender, n (%)	1083 (28.3)
Geographical origin, n (%)
Italy	3118 (81.6)
Foreign	699 (18.3)
Africa	363 (9.5)
South/Central America	104 (2.7)
East Europe	114 (3)
Asia/Australia	61 (1.6)
Other countries	57 (1.5)
Other/unknown	5 (0.1)
Risk factor for HIV acquisition, n (%)
Heterosexual	1607 (42)
IVDU	1083 (28.3)
MSM/bisex	825 (21.6)
Sexual (ns)	37 (1)
Vertical	28 (0.7)
Other/unknown	242 (6.3
On cART, n (%)	3754 (98.2)
CD4+ count median	651.9
CD4+ count, n (%)^a
<50	12 (0.3)
51–200	170 (4.7)
201–350	352 (9.8)
>350	3051 (85.1)
HIV RNA^b
Undetectable, n (%)	3308 (93.3)
<30,000	207 (5.8)
>30,000	29 (0.8)
HCV infection, n (%)	1372 (35.9)
AIDS diagnosis during linkage, n (%)	277 (7.2)

Data were updated in June 2018.

ns: non specified; IVDU: intravenous drug user; MSM: men who have sex with men.

^aAvailable data for 3586 patients.

^bAvailable data for 3544 patients.

Table 2 Distribution Number of HIV patients in follow-up and with new diagnosis and number and percentage of those with loss to follow-up (LTFU) of LTFU by observation year (2012–2018)

Year of last contact	HIV patients in follow up at beginning of the year	New diagnosis during the year	LTFU (n, % of patients in follow up)
2012	3546	113	69 (1.89)
2013	3590	137	53 (1.44)
2014	3674	129	59 (1.59)
2015	3744	110	48 (1.28)
2016	3806	87	71 (1.89)
Jan–Apr 2017	3822	30	5 (0.13)^a

^a Small percentage explained by the short period of observation (observation period finished in April 2018 and then we could only consider last contacts that occurred within April 2017 to have 12 months needed to define LTFU).

Table 3 Characteristics of patients with loss to follow-up (LTFU): all (n = 305), old diagnosis (n = 209) or new diagnosis (n = 96) at the time of loss to follow up

Characteristics	HIV cohort LTFU	LTFU among new HIV diagnosed patients	LTFU among old HIV diagnosed patients
Total	305	96	209
Age, yr, mean (range)	40 (17–75)	37 (19–65) *	42 (18–75)*
Female gender, n (%)	116 (38.1)	42 (43.7)	74 (35.4)
Geographical origin, n (%)
Italy	149 (48.8)	33 (34.4)*	116 (55.5)*
Foreign	156 (51.1)	63 (65.6)	93 (44.5)
Africa	91 (29.8)	42 (43.8)	49 (23.4)
South/Central America	31 (10.2)	6 (6.3)	25 (12)
East Europe	21 (6.9)	12 (12.5)	9 (4.3)
Asia	7 (2.3)	3 (3.1)	4 (1.9)
Others	6 (2)	0	6 (2.8)
Risk factor for HIV acquisition, n (%)
Heterosexual	147 (53.9)	62 (64.6)*	85 (40.7)*
IVDU	68 (24.9)	7 (7.3)*	61 (29.2)*
MSM/bisex	55 (20.2)	17 (17.7)	38 (18.2)
Vertical	3 (1.1)	0	3 (1.4)
Other/unknown	32 (10.5)	10 (10.4)	22 (10.5)
On cART, n (%)	261 (85.6)	70 (73)	191 (91.4)
CD4+ count
>200 cells/μl at diagnosis, n (%)	225 (76.5)	70 (72.9)	155 (67.7)
at diagnosis (cells/μl), median (range)	360.5 (3–1471)	363 (4–1471)	358.5 (3–1363)
>200 cells/μl at last contact, n (%)	254 (85)	76 (79.2)	178 (85.2)
at last contact (cells/μl), median (range)	549 (5–1548)	489 (11–1520)	561 (5–1548)
HIV RNA
undetectable at last contact, n (%)	159 (53.5)	40 (41.7)**	117 (56) **
at last contact (copies/ml), mean (range)	95,126 (0–8,642,000)	202,267 (0–8,642,000)	6396 (0–239,200)
HCV infection, n (%)	49 (16.1)	12 (12.5)	76 (36.4)
AIDS diagnosis during linkage, n (%)	49 (16.1)	12 (12.5)	37 (17.7)

Comparison between LTFU patients with new and old diagnosis: *p < 0.001, **p < 0.05.

Table 4 Characteristics of LTFU patients re-engaged in care in comparison with LTFU patients

Characteristics	LTFU patients	Re-engaged in care patients
Total	305	43
Age, yr, mean (range)	40 (17–75)	37.8 (17–66)
Female gender, n (%)	116 (38)	18 (41.9)
Geographical origin, n (%)
Italy	149 (48.8)	23 (53.5)
Foreign	156 (51.1)	20 (46.5)
Africa	91 (29.8)	12 (27.9)
South/Central America	31 (10.2)	4 (9.3)
East Europe	21 (6.9)	4 (9.3)
Asia	7 (2.3)	0
Others	6 (2)	0
Risk factor for HIV acquisition, n (%)
Heterosexual	147 (53.9)	21 (52.5)
IVDU	68 (24.9)	13 (32.5)
MSM/bisex	55 (20.2)	5 (12.5)
Vertical	3 (1.1)	1 (2.5)
Other/unknown	32 (10.5)	3 (6.9)
On cART, n (%)	261 (85.6)	35 (81.4)
CD4+ count
>200 cells/μl at diagnosis, n (%)	225 (76.5)	31 (73.8)
at diagnosis (cells/μl), median (range)	418 (3–1471)	329.5 (6–1471)
>200 cells/μl at last contact, n (%)	254 (85)	35 (81.4)
at last contact (cells/μl), median	552 (5–1548)	491.5 (3–1417)
>200 cells/μl at re-engagement, n (%)		15 (39.5)
at re-engagement, median (range)		119.5 (2–788)
HIV RNA*
undetectable at last contact, n (%)	159 (53.5)*	15 (34.8)*
at last contact (copies/ml), mean (range)	66,154 (0–8,642,000)	7548 (0–70,430)
at re-engagement (copies/ml), mean (range)		88,303 (144–683,700)
HCV infection, n (%)	88 (29.4)	16 (37.2)
AIDS diagnosis during linkage, n (%)	49 (16.1)	9 (20.9)

* p-value 0.008.

Figure 2 Proportions of HIV cohort patients (2012–2018) by stage of HIV continuum of care.

Figure 3 Proportions of new HIV infected patients by stage of HIV cascade of care.