By David Douglas

NEW YORK (Reuters Health) - Patients infected with HIV, the virus that causes AIDS, who fail to show up for scheduled clinic appointments during their first year of treatment are more likely to die over the long term than patients with perfect attendance, a new study shows.

"For HIV care providers, missed visits shortly after establishing outpatient care serve as a marker identifying patients at higher risk for poor clinical outcomes -- patients who may require closer monitoring," study leader Dr. Michael J. Mugavero told Reuters Health.

Even after controlling for immune system function at the outset and HIV drug therapy in the first year of care, patients who missed visits had more than twice the rate of death during follow-up compared to those who attended all their scheduled appointments.

The study by Mugavero and colleagues at the University of Alabama at Birmingham involved 543 patients who started outpatient care for HIV between 2000 and 2005. Of this group, 60 percent missed scheduled office visits during the first year.

The mortality rate for patients who made all scheduled visits was 1 per 100 persons per year compared to 2.3 per 100 persons per year in those with missed visits.

Furthermore, the increased risk of death was similar whether patients had missed only 1, or 2 or more visits.

"Considering tens of thousands of individuals are newly diagnosed with HIV infection in the US annually, and the high frequency of missed visits in the first year of care -- which was associated with over a two-fold increase in mortality in our study -- extrapolation of our findings to the general population level has profound public health implications," concluded Mugavero.

SOURCE: Clinical Infectious Diseases, January 2009.

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