Factors associated with medical management of HIV-infected persons in two French districts, 1993-1995

Background: The regularity of medical follow-up of HIV-infected patients gr eatly influences the effectiveness of antiretroviral treatments and of prop hylaxis of opportunistic infections. Methods: To identify potential barriers to a regular follow-up, a retrospec tive study was conducted among the adult AIDS patients diagnosed between Ju ly 1993 and May 1995 in two French districts (Gironde and Hauts-de-Seine). Medical follow-up was described based on the frequency of CD4 counts in the medical file and on a confidential interview among patients whose HIV infe ction had been diagnosed at least 6 months before AIDS. Irregular follow-up (less than one CD4 count per year when CD4 > 500/mm(3), and per 6-months w hen CD4 < 500/mm(3)) within the two years preceding AIDS diagnosis was anal ysed according to socioeconomic status and to social and behavioral factors . Results: Among 290 patients, follow-up was irregular in 51% of the patients (injecting drug users: 66%, homo/bisexual men: 41%, patients infected thro ugh heterosexual contact: 49%, p< 0.01). Factors independently associated w ith irregular follow-up were low income level (adjusted odds ratio (aOR) = 2.4; 95% confidence interval (CI), 1.4-4.1); absence of regular practitione r at HIV diagnosis (aOR = 1.9; 95% CI 1.1-3.3); imprisonment between HIV di agnosis and AIDS (aOR = 3.8; 95% CI 1.3-10.9), and being non homo/bisexual male (aOR = 2.4; 95% CI 1.1-5.1) versus homo/bisexual male (aOR = 1.3; 95% CI 0.7-2.7) and female (reference). Conclusions: Results of this study show that several socioeconomic, psychol ogical and cultural barriers to a regular pre-AIDS medical follow-up still exist. Impact of new antiretroviral therapy may only be optimal if these ba rriers are overcome.