Objective To evaluate the incidence, potiential reasons, and survival impact of antiretroviral therapy (ART) attrition among HIV/AIDS patients in Jiamusi, Heilongjiang province, and to provide evidence for optimizing treatment continuity and public health policies.

Methods This retrospective cohort study utilized data from the National Comprehensive AIDS Prevention and Control Information System of China Information System for Disease Prevention and Control. We included HIV/AIDS patients who received ART in Jiamusi between January 1, 2008 and December 31, 2022, if they were local residents and aged ≥15 years at diagnosis. Study outcomes were ART attrition (defined as treatment discontinuation or lost to follow-up) and death. Survival curves were constructed using Kaplan-Meier method and Log-rank tests were performed. Cox proportional hazards models were employed to analyze the effect of ART attrition on mortality risk.

Results Among 1 009 HIV/AIDS patients included, the ART attrition rate was 5.45% (55/1 009). Primary reasons for attrition included self-perceived good health (65.71%), barriers to cross-regional medical care (51.43%), financial burden (42.86%), adverse drug reactions (37.14%), self-purchased medications or traditional Chinese medicine use (14.28%), and adherence challenges (8.57%). The ART attrition group exhibited significantly lower 1-year, 3-year and 5-year survival rates (85.45%, 80.00% and 78.18%, respectively) compared to the non-attrition group (94.44%, 92.14% and 90.88%; Log-rank test, P<0.001). Cox regression model analysis demonstated that ART attrition significantly increased mortality risk (hazard ratio=4.39, 95% confidence interval: 2.33−8.29, P<0.001). Other factors influencing mortality risk included age, education level, sources of HIV testing, and baseline CD4⁺T cell counts.

Conclusion ART attrition negatively impacts survival outcomes in HIV/AIDS patients. Targeted interventions are urgently needed including individualized health education, financial assistance programs, and enhanced ART adherence support for high-risk populations. For patients prone to ART attrition, it is crucial to optimize cross-regional healthcare coordination mechanisms and strengthen follow-up protocols with integrated support services to improve long-term survival.