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Objective: The purpose of this study was to evaluate how poor retention in HIV care impacts time to viral suppression after initiating highly active antiretroviral therapy. Methods: A retrospective cohort study design, employing a medical chart review, was conducted at an academic infectious disease clinic at the University of Kentucky. Patients seeking care between 2003 and 2011 were included in the study. A log-normal model was employed to determine the factors associated with time to viral suppression. Results: Of the 532 patients in the study, 426 (80.1%) patients were virally suppressed. Controlling for insurance status, race, baseline CD4 counts, and viral loads, the expected time to viral suppression for nonoptimal retainers was longer compared to optimal retainers (100% retained in care; time ratio: 2.04; 95% confidence interval: 1.40-2.90). Conclusion: Researchers should continue to study the impact of retention on clinical outcomes and strategies to improve retention and reengage those lost to follow-up back into care. © The Author(s) 2013.