Pill Burden, Drug Use, Mental Illness, and Imprisonment and the Impact on Retention Rates for Human Immunodeficiency Virus (HIV)/Hepatitis C Co-Infected Patients in South Carolina

Abstract

Background. For HIV patients, poor retention has been linked to poor clinical outcomes. The same may be assumed for those patients co-infected with Hepatitis C (HCV), although little has been reported. In this study we evaluate factors thought to negatively impact retention of co-infected patients in an urban clinic in South Carolina, specifically pill burden, comorbidities, mental illness, imprisonment, and intravenous drug usage (IVDU). Methods. A retrospective cohort study was used to evaluate patients in our clinic whose initial visit was between 2006 and 2012. Patients seen prior to 2006 who were lost to follow up for more than 2 years then re-established care were also included. Retention was defined as at least 2 visits, divided by 90 days within a 1 year period. Data from initial and subsequent visits was collected for three years. Results. Within our cohort, 82% were male, 61% were African American, and the mean age was 55. Increased numbers of pills, medications, and comorbidities trended towards decreased retention. More than 50% of this population also had IVDU and mental illness. Retention waned over time but did not vary significantly by patient risk factor. Conclusion. Overall, this population had declining retention over time, especially at three years. While IVDU, mental illness, and imprisonment seem to be an impediment to retention in care, the data did not demonstrate a dramatic difference from the total population. Patients who were not retained trended towards increased burden of pill count, medications, and comorbidities, thus consolidation of therapy may improve retention. (Table Presented) .