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Objectives: The aim of our study was to identify HIV-positive patients at risk of medical care interruption (MCI) in a provincial city of a high-income country., Methods: We estimated the incidence rate of MCI in 989 individuals followed in an HIV clinic in Caen University Hospital, Normandy, France, between January 2010 and May 2016. We enrolled patients over 18 years old who were seen at the clinic at least twice after HIV diagnosis. Patients were considered to be in MCI if they did not attend care in or outside the clinic for at least 18 months, regardless of whether or not they came back after interruption. We investigated sociodemographic, clinical and immunovirological characteristics at HIV diagnosis and during follow-up through a Cox model analysis., Results: The incidence rate of MCI was estimated to be 3.0 per 100 persons-years (95% confidence interval [CI] = 2.6-3.5). The independent risk factors for MCI were a linkage to care >6 months after HIV diagnosis (hazard ratio [HR] = 1.14; 95% CI = 1.08-1.21), a hepatitis C coinfection (HR = 1.76; 95% CI = 1.07-2.88), being born in Sub-Saharan Africa (HR = 2.18; 95% CI = 1.42-3.34 vs. in France) and not having a mailing address reported in the file (HR = 1.73; 95% CI = 1.07-2.80). During follow-up, the risk of MCI decreased when the patient was older (HR = 0.28; 95% CI = 0.15-0.51 when >45 vs. ≤ 30 years old) and increased when the patient was not on antiretroviral therapy (HR = 2.78; 95% CI = 1.66-4.63)., Conclusions: Our findings show that it is important to link HIV-positive individuals to care quickly after diagnosis and initiate antiretroviral therapy as soon as possible to retain them in care., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: JJP reports grants from ViiV Healthcare and MSD, and personal fees from Gilead, ViiV Healthcare and MSD outside the present work. KC has served as a speaker and as a consultant for Gilead outside the present work. YY has served as a speaker and as a consultant for Abbott, Bristol-Myers Squibb, Gilead, MSD, Roche, Tibotec and ViiV Healthcare outside the present work. RV received travel grants from Gilead, Merck and ViiVHealthCare outside the present work. ALF, PF and EP have no conflicts of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objectives: With HIV treatment as a prevention strategy, retention in care remains a key for sustained viral suppression. We sought to identify HIV-infected patients at risk for medical care interruption (MCI) in a high-income country., Methods: The HIV-infected patients enrolled had to attend the clinic at least twice between January 2010 and October 2014 and were followed up until May 2016. MCI was defined as patients not seeking care in or outside the clinic for at least 18 months, regardless of whether they returned to care after the interruption. The association between MCI and sociodemographic, clinical, and immuno-virological characteristics at HIV diagnosis and during follow-up was assessed using Cox models., Results: The incidence rate of MCI was 2.5 per 100 persons-years (95% confidence interval [CI] = 2.3-2.7). MCI was more likely in patients who accessed care >6 months after diagnosis (hazard ratio [HR] = 1.30, 95% CI = 1.10-1.54 vs. ≤6 months) or did not report a primary care physician (HR = 2.40; 95% CI = 2.03-2.84). MCI was less likely in patients born in sub-Saharan Africa (HR = 0.75, 95% CI = 0.62-0.91 vs. born in France). During follow-up, the risk of MCI increased when the last CD4 count was ≤350 (HR = 2.85, 95% CI = 2.02-4.04 vs. >500 cells/mm3) and when the patient was not on antiretroviral therapy (HR = 3.67, 95% CI = 2.90-4.66)., Conclusions: The incidence of MCI is low in this hospital that serves a large proportion of migrants. Low or no recorded CD4 counts for a medical visit could alert of a higher risk of MCI, even more in patients who accessed HIV care late or did not report a primary care physician., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following updated competing interests: YY has served as a speaker and as a consultant for Abbott, Bristol-Myers Squibb, Gilead, MSD, Roche, Tibotec and ViiV Healthcare outside the present work. KC has served as a speaker and as a consultant for Gilead outside the present work. RV received travel grants from Gilead, Merck and ViiVHealthCare outside the present work. JJP reports grants from ViiV Healthcare and MSD, and personal fees from Gilead, ViiV Healthcare and MSD outside the present work. RL reports grants from ViiV Healthcare, MSD, and personal fees from Gilead, ViiV Healthcare, Janssen and MSD outside the present work. SL reports personal fees from MSD outside the present work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.