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Objective:

To determine the association between rural residence and HIV outcomes.

Design, Setting, and Patients:

Retrospective cohort study of mortality among persons initiating HIV care in Veterans Administration (VA) during 1998–2006, with mortality follow-up through 2008. Rural residence was determined using Rural Urban Commuting Area codes. We identified 8489 persons initiating HIV care in VA with no evidence of combination antiretroviral therapy (cART) use at care entry, of whom 705 (8.3%) were rural.

Outcome Measure:

All-cause mortality.

Results:

At care entry, rural persons were less likely than urban persons to have drug use problems (10.6% vs. 19.5%, P< 0.001) or hepatitis C (34.3% vs. 41.2%, P= 0.001), but had more advanced HIV infection (median CD4: 186 vs. 246, P< 0.001). By 2 years after care entry, 5874 persons had initiated cART (528 rural [74.9%] and 5346 urban [68.7%], P= 0.001), and …