Factors associated with loss to follow-up among people with HIV in France

INTRODUCTION: People with HIV (PWH) with interrupted medical care have a higher risk of viral rebound. We investigated the factors associated with loss to follow-up (LTFU) by combining socioeconomic data from three research cohorts with the nationwide follow-up data of the French Hospital Database on HIV (ANRS-CO4-FHDH). METHODS: We included individuals who entered the ANRS PRIMO (primary HIV-1 infection), CODEX (HIV-1 controllers), and COPANA (recent HIV-1 diagnosis) cohorts. Data were then linked to those of the FHDH. LTFU was defined as no clinical follow-up for at least 24 months on 31 December 2021. Fine and Gray's subdistribution hazard models taking the competing risk of death into account were used to identify factors associated with LTFU. RESULTS: We included 2935 PWH in this study: 576 women, 1879 MSM and 480 MSW (men who have sex with women). In total, 605 participants were lost to follow-up in terms of hospital care. The cumulative incidence of LTFU was 16% [95% confidence interval (CI): 15-18] at 10 years. Migrant MSM and MSW had a higher risk of LTFU than French-born MSM [adjusted subdistribution hazard ratios (aSHR): 1.68 (95% CI: 1.27-2.21) and 1.38 (0.98-1.96), respectively]. Younger age, unemployment [aSHR: 1.24 (1.01-1.53)], antidepressant prescription [aSHR: 1.80 (1.21-2.67)] at inclusion, and lack of ART initiation [aSHR: 8.33 (6.25-12.50)] during follow-up were also associated with a higher risk of LTFU. CONCLUSION: A migrant background, unemployment, and antidepressant prescription were associated with LTFU, highlighting the need for targeted support for vulnerable groups to improve engagement with care.