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Introduction <p>The incidence rate of newly diagnosed HIV infection in Indonesia decreased from 21 per 100,000 in 2011 to 10 per 100,000 in 2021. Despite this progress, AIDS-related deaths among people living with HIV (PLWH) increased from 3.4% in 2010 to 4.8% in 2020. Determining risk factors for mortality may identify areas to intervene and reduce mortality.</p> Methods <p>A multicenter, prospective, observational cohort study of HIV infection, coinfections, and comorbidities (INA-PROACTIVE) was carried out at 19 hospitals across major islands in Indonesia. The study enrolled PLWH from 2018–2020 and followed them for 3&#xa0;years. For this analysis, PLWH ≥ 18&#xa0;years old with one year of follow-up data were included. Cox regression was used to identify variables at enrollment that correlated with one-year mortality.</p> Results <p>Among the 4,050 PLWH analysed in the study, 68.8% were male, 53.5% acquired HIV through heterosexual transmission, 92.4% were on antiretroviral treatment (ART) at enrollment, and 72.4% had an undetectable viral load. At one year, 115 (2.8%) had died. Detectable viremia at enrollment was significantly associated with mortality, with the risk increasing as the viral load (VL) category increased (adjusted hazard ratio [aHR] 4.47, 95% CI: 1.47–13.56 for VL 50 to &lt; 1,000 copies/mL; aHR 7.88, 95% CI: 2.80–22.20 for VL 1,000 to 10,000 copies/mL; and aHR 18.33, 95% CI: 7.94–42.34 for VL &gt; 10,000 copies/mL; compared to VL &lt; 50 copies/mL). Other factors at enrollment significantly associated with mortality were a CD4 + count &lt; 200 (aHR 8.02, 95% CI: 2.69–23.86; compared to ≥ 350), age 40–49&#xa0;years (aHR 2.19, 95% CI 1.23–3.87; compared to 18–29&#xa0;years) and being underweight (aHR 1.84, 95% CI: 1.18–2.85; compared to normal weight).</p> Conclusions <p>Among predominantly treatment-experienced PLWH, detectable viremia and continued immunosuppression were significantly associated with one-year mortality. This study highlights the importance of ART with complete viral suppression as well as immune recovery to prevent mortality.</p> Trial registration <p>Clinical Trial Number: NCT03663920, registration date: 4 January 2018.</p>

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A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality

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    2025年1月20日

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  • Tuti P. Merati,
  • Evy Yunihastuti,
  • Rudi Wisaksana,
  • Nia Kurniati,
  • Dona Arlinda,
  • Muhammad Karyana,
  • Nugroho H. Susanto,
  • Dewi Lokida,
  • Herman Kosasih,
  • Aly Diana,
  • Lois E. Bang,
  • Melinda Setiyaningrum,
  • Desrinawati M. Amin,
  • Eppy Eppy,
  • Wiwit A. S. N. Cahyawati,
  • Emon W. Danudirgo,
  • I Made Gede Darmaja,
  • Nur Farhanah,
  • Carta A. Gunawan,
  • Usman Hadi,
  • Kurnia F. Jamil,
  • Sudirman Katu,
  • Tambar Kembaren,
  • I Gede Rai Kosa,
  • Danang L. Norosingomurti,
  • Asep Purnama,
  • Ida S. Laksanawati,
  • Adria Rusli,
  • I Ketut Agus Somia,
  • Yanri W. Subronto,
  • Ivan L. Toruan,
  • Renee Ridzon,
  • C. Jason Liang,
  • Aaron T. Neal,
  • Ray Y. Chen,
  • Agnes Rengga Indrati,
  • Anggraini Alam,
  • Syndi Nurmawati,
  • Nurul Hidayah Chairunnisa,
  • Octavia Kartika Dwi,
  • Hofiya Djauhari,
  • Sigit Sunarko,
  • Tuti Parwati Merati,
  • IKetut Agus Somia,
  • IMade Susila Utama,
  • Ni Made Dewi Dian Sukmawati,
  • Anak Agung Yuli Gayatri,
  • Ketut Dewi Kumara Wati,
  • Anak Agung Wiradewi Lestari,
  • Ni Nengah Dwi Fatmawati,
  • Ni Luh Putu Ariastuti,
  • Ni Putu Satriawati,
  • Ni Ketut Lestari,
  • Ni Wayan Desi Jumanti,
  • Ni Nyoman Setiani,
  • IGede Purinawa,
  • Desak Putra Artini,
  • Ni Nyoman Seri Sutarni,
  • July Kumalawati,
  • Fadlika Harinda,
  • Tiara Kumala Putri,
  • Madyaningati,
  • Wusthi Ali Chasanah,
  • Desrinawati Muhammad Amin,
  • Teguh Sarry Hartono,
  • Adria Rusli,
  • Nisrina Fatin Mardiyah,
  • Ayu Reskianingsih,
  • Evi Hindawati,
  • Fitriani,
  • Sudirman Katu,
  • Ninny Meutia Pelupessy,
  • Munawir,
  • Asvin Nurulita,
  • Dhiny Reskita Ayu,
  • Rizky Auliah Bakri,
  • Muhammad Fiqhi Hardiansyah,
  • Dewi Sriyanti,
  • Kartini,
  • Nasruh Nurdin,
  • Andi Tessyoja,
  • Nur Farhanah,
  • Muchlis Achsan Udji Sofro,
  • Nahwa Arkhaesi,
  • Muji Rahayu,
  • Rohedy Adlina,
  • Erni,
  • Trie Wahyuningtias,
  • Bayu Sampurmantoro Kusumo,
  • Ngatno,
  • Usman Hadi,
  • Dwiyanti Puspitasari,
  • Munawaroh Fitriah,
  • Muhammad Vitanata Arfijanto,
  • Bramantono,
  • Musofa Rusli,
  • Myrna Evanda Adeline,
  • Rifaa’ah Rosyiidah,
  • Misutarno,
  • Yuanita Bahar,
  • Diah Wahyuni,
  • Hera Nirwati,
  • Ida Safitri Laksanawati,
  • Yanri Wijayanti Subronto,
  • Umi Solekhah Intansari,
  • Vitia Ajeng Nur Linda,
  • Diajeng Gayatri Kusumaningtyas,
  • Siti Binzanah,
  • Linda Oktabriana,
  • Eppy Eppy,
  • Heidy Agustin,
  • Fauzi Mahfuzh,
  • Dewi Yennita Sari,
  • Titin Dani Martiwi,
  • Putri Permata Sari,
  • Ariesta Putra Indoin,
  • Susetianingsih,
  • Tri Mulyani,
  • Tambar Kembaren,
  • Rita Evalina,
  • Nelly Elfrida Samosir,
  • Cicimei Putri Siregar,
  • Iramaya Oktariana Harahap,
  • Junita Siahaan,
  • Ennyke Karolina Ginting,
  • Melpinna Fretty Marpaung,
  • IGede Rai Kosa,
  • Chakrawati Hayuningsih,
  • Arif Budiman,
  • Cintya Naya Danastri,
  • Ivana Yulian Hendarsin,
  • Husnul Chotimah,
  • Evi Herawati,
  • Suyono,
  • Wiwit Agung Sri Nur Cahyawati,
  • Dwiana Savitri,
  • Rahmawati,
  • Priyanti Kisworini,
  • Regina Septiana,
  • Rizka Dwi Puteri,
  • Lutfia Rahimah,
  • Silvia Rahmi Astuti,
  • Irma Meilyana Fajar Utami,
  • Setiawati,
  • Emon Winardi Danudirgo,
  • Elizabeth Yohmi,
  • Deborah Theresia,
  • Janice Tandraeliene,
  • Cicilia Ina Prihsetyati,
  • Lili,
  • Danang Legowo Norosingomurti,
  • Willy Anthony Iqnatius Wullur,
  • Nisa Trini Asnil,
  • Francisca Lianiwati Tanzil,
  • Glegery Putri Hardoni,
  • Winny Wangun Lestari Wullur,
  • Mutamimah,
  • Diana Sulastri,
  • Friska Sitorus,
  • Carta A. Gunawan,
  • Sunarto Ang,
  • Sri Wahyunie,
  • Hendra,
  • Andini Agustyana,
  • Edwin Prasetya,
  • Monika Lestari Palondongan,
  • Heniastuti,
  • Nursiah Mukano,
  • Ady Achmaddany,
  • Kurnia Fitri Jamil,
  • Mulya Safri,
  • Vivi Keumala Mutiawati,
  • Muhammad Abrar Azhar,
  • Ika Novita,
  • Muslim,
  • Nurul Husna,
  • Ella Firbria,
  • Arfajah,
  • Ivan Lumban Toruan,
  • Muchamad Budi Nugroho,
  • Handoko Halim,
  • Wiwi Endang Susanti,
  • Redha Vebrina,
  • Ike Rahmawati,
  • Herlina,
  • Sudaryanto,
  • Emy Suyanti,
  • IMade Gede Darmaja,
  • Immaculata Purwaningsih,
  • Justina Sembiring,
  • Nur Yanti,
  • Nani Emma,
  • Widya Amalia Swastika,
  • Sunarti,
  • Martha Magdalena Ayer,
  • Asep Purnama,
  • Mario Bernardinus Realino Nara,
  • Dwi Kurniawan Nugroho,
  • Putri Nur Indah Sari,
  • Ulul Azmiyah Riawan,
  • Fransiska Mathilde,
  • Kurniawati Handayani Koli,
  • Stefani Marwah Tolok,
  • Maria Yupina Yuanti,
  • Muhammad Karyana,
  • Dona Arlinda,
  • Herman Kosasih,
  • Dewi Lokida,
  • Adhella Menur Naysilla,
  • Aly Diana,
  • Chandra Ilham El Anwary Junior,
  • Deni Pepy Rentina Butarbutar,
  • Eka Windari Rusman,
  • IWayan Adi Pranata,
  • Lois Eirene Bang,
  • Meity Siahaan,
  • Melinda Setiyaningrum,
  • Nada Ariqa,
  • Nugroho Harry Susanto,
  • Nur Latifah Hanum,
  • Nurhayati Lukman,
  • Restu Amalia Mukti,
  • Rizki Amalia Sari,
  • Tiya Saraswati,
  • Virtania Meirina Agusta,
  • Wahyu Nawang Wulan,
  • Ray Y. Chen,
  • Aaron T. Neal,
  • C. Jason Liang,
  • Renee Ridzon,
  • Chuen-Yen Lau,
  • Louis Grue,
  • Jacqueline Perodin,
  • Katie Watkins

摘要

Introduction

The incidence rate of newly diagnosed HIV infection in Indonesia decreased from 21 per 100,000 in 2011 to 10 per 100,000 in 2021. Despite this progress, AIDS-related deaths among people living with HIV (PLWH) increased from 3.4% in 2010 to 4.8% in 2020. Determining risk factors for mortality may identify areas to intervene and reduce mortality.

Methods

A multicenter, prospective, observational cohort study of HIV infection, coinfections, and comorbidities (INA-PROACTIVE) was carried out at 19 hospitals across major islands in Indonesia. The study enrolled PLWH from 2018–2020 and followed them for 3 years. For this analysis, PLWH ≥ 18 years old with one year of follow-up data were included. Cox regression was used to identify variables at enrollment that correlated with one-year mortality.

Results

Among the 4,050 PLWH analysed in the study, 68.8% were male, 53.5% acquired HIV through heterosexual transmission, 92.4% were on antiretroviral treatment (ART) at enrollment, and 72.4% had an undetectable viral load. At one year, 115 (2.8%) had died. Detectable viremia at enrollment was significantly associated with mortality, with the risk increasing as the viral load (VL) category increased (adjusted hazard ratio [aHR] 4.47, 95% CI: 1.47–13.56 for VL 50 to < 1,000 copies/mL; aHR 7.88, 95% CI: 2.80–22.20 for VL 1,000 to 10,000 copies/mL; and aHR 18.33, 95% CI: 7.94–42.34 for VL > 10,000 copies/mL; compared to VL < 50 copies/mL). Other factors at enrollment significantly associated with mortality were a CD4 + count < 200 (aHR 8.02, 95% CI: 2.69–23.86; compared to ≥ 350), age 40–49 years (aHR 2.19, 95% CI 1.23–3.87; compared to 18–29 years) and being underweight (aHR 1.84, 95% CI: 1.18–2.85; compared to normal weight).

Conclusions

Among predominantly treatment-experienced PLWH, detectable viremia and continued immunosuppression were significantly associated with one-year mortality. This study highlights the importance of ART with complete viral suppression as well as immune recovery to prevent mortality.

Trial registration

Clinical Trial Number: NCT03663920, registration date: 4 January 2018.