A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality
Abstract 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...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12879-024-10354-8 |
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| author | 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 INA-PROACTIVE Study Group |
| author_facet | 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 INA-PROACTIVE Study Group |
| author_sort | Tuti P. Merati |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-d9f916dc530c4c05842511be9fa7a96e |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-d9f916dc530c4c05842511be9fa7a96e2025-01-26T12:17:06ZengBMCBMC Infectious Diseases1471-23342025-01-0125111310.1186/s12879-024-10354-8A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortalityTuti P. Merati0Evy Yunihastuti1Rudi Wisaksana2Nia Kurniati3Dona Arlinda4Muhammad Karyana5Nugroho H. Susanto6Dewi Lokida7Herman Kosasih8Aly Diana9Lois E. Bang10Melinda Setiyaningrum11Desrinawati M. Amin12Eppy Eppy13Wiwit A. S. N. Cahyawati14Emon W. Danudirgo15I Made Gede Darmaja16Nur Farhanah17Carta A. Gunawan18Usman Hadi19Kurnia F. Jamil20Sudirman Katu21Tambar Kembaren22I Gede Rai Kosa23Danang L. Norosingomurti24Asep Purnama25Ida S. Laksanawati26Adria Rusli27I Ketut Agus Somia28Yanri W. Subronto29Ivan L. Toruan30Renee Ridzon31C. Jason Liang32Aaron T. Neal33Ray Y. Chen34INA-PROACTIVE Study GroupDepartment of Internal Medicine, Faculty of Medicine, Universitas UdayanaFaculty of Medicine, Cipto Mangunkusumo Hospital, Universitas IndonesiaFaculty of Medicine, Hasan Sadikin General Hospital, Universitas PadjadjaranFaculty of Medicine, Cipto Mangunkusumo Hospital, Universitas IndonesiaIndonesia Research Partnership On Infectious Diseases (INA-RESPOND)Indonesia Research Partnership On Infectious Diseases (INA-RESPOND)Indonesia Research Partnership On Infectious Diseases (INA-RESPOND)Indonesia Research Partnership On Infectious Diseases (INA-RESPOND)Indonesia Research Partnership On Infectious Diseases (INA-RESPOND)Indonesia Research Partnership On Infectious Diseases (INA-RESPOND)Indonesia Research Partnership On Infectious Diseases (INA-RESPOND)Indonesia Research Partnership On Infectious Diseases (INA-RESPOND)Prof. Dr. Sulianti Saroso Infectious Disease HospitalPersahabatan Central General HospitalDr. Moch. Ansari Saleh HospitalSt. Carolus HospitalAbepura Regional General HospitalDepartment of Internal Medicine, Faculty of Medicine, Universitas Diponegoro/Dr, Kariadi HospitalFaculty of Medicine, Abdoel Wahab Sjahranie General Hospital, Universitas MulawarmanDepartment of Internal Medicine, Faculty of Medicine, Universitas Airlangga/Dr, Soetomo General Academic HospitalDr. Zainoel Abidin Hospital/Faculty of Medicine, Universitas Syiah KualaDr. Wahidin Sudirohusodo HospitalAdam Malik HospitalTangerang District HospitalBudi Kemuliaan HospitalDr. T. C. Hillers Public HospitalDepartment of Child Health, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah MadaProf. Dr. Sulianti Saroso Infectious Disease HospitalDepartment of Internal Medicine, Faculty of Medicine, Ngoerah Hospital, Universitas UdayanaDepartment of Internal Medicine/Magister of Tropical Medicine Study Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General HospitalSoedarso General HospitalNational Institute of Allergy and Infectious Diseases, National Institutes of HealthNational Institute of Allergy and Infectious Diseases, National Institutes of HealthNational Institute of Allergy and Infectious Diseases, National Institutes of HealthNational Institute of Allergy and Infectious Diseases, National Institutes of HealthAbstract 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.https://doi.org/10.1186/s12879-024-10354-8HIVIndonesiaMortalityRisk factorsAdult cohortViremia |
| spellingShingle | 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 INA-PROACTIVE Study Group A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality BMC Infectious Diseases HIV Indonesia Mortality Risk factors Adult cohort Viremia |
| title | A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality |
| title_full | A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality |
| title_fullStr | A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality |
| title_full_unstemmed | A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality |
| title_short | A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality |
| title_sort | prospective observational cohort study of hiv infection in indonesia baseline characteristics and one year mortality |
| topic | HIV Indonesia Mortality Risk factors Adult cohort Viremia |
| url | https://doi.org/10.1186/s12879-024-10354-8 |
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