Poor retention in care one-year after viral suppression: a significant predictor of viral rebound

Abstract

Optimal retention in care should be continuously monitored even after suppression to prevent the risk of viral rebound. The purpose of this study is to assess the association between retention in care and viral rebound 12 months after viral suppression. A retrospective medical chart review study was conducted at an academic clinic in Lexington, KY, to determine an association between retention in care and viral rebound. A total of 658 patients, who were virally suppressed at any time between 2003 and 2009, were followed for 12 months after viral suppression. Retention in care was defined as having at least one clinic visit every three months (visit constancy) and viral rebound was defined as a viral load >400 copies/ml. Of the 658 patients included in the study, 43% were less than optimally retained in care and 26% had a viral rebound 12 months after suppression. In the multivariable logistic regression model, the odds of a viral rebound were much greater for suboptimal (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.44–3.63) and poor (OR: 15.1; 95% CI: 6.82–33.41) retainers compared to optimal retainers. The results of the study suggest that retention in HIV care plays a central role in maintaining optimal outcomes such as viral suppression. Interventions that target improvement in retention in care among those who are poorly retained must be set in place in order to reduce the risk of a viral rebound.

Keywords:

• retention in care
• viral load rebound
• viral suppression
• visit constancy
• HIV engagement in care