Meijerink Hinta, Wisaksana Rudi, Iskandar Shelly, den Heijer Martin, van der Ven Andre J A M, Alisjahbana Bachti, van Crevel Reinout
Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Department of Internal Medicine, Medical Faculty, Universitas Padjadjaran and Hasan Sadikin Hospital, Bandung, Indonesia.
J Int AIDS Soc. 2014 Jan 3;17(1):18844. doi: 10.7448/IAS.17.1.18844. eCollection 2014.
It remains unclear whether the natural course of human immunodeficiency virus (HIV) differs in subjects infected through injecting drug use (IDU) and no data have been published from low- or middle-income countries. We addressed this question in an urban cohort in Indonesia, which is experiencing a rapidly growing HIV epidemic strongly driven by IDU.
All antiretroviral treatment (ART) naïve HIV-positive patients who had at least two subsequent CD4 cell counts available before starting ART were included in this study. We examined the association between IDU and CD4 cell decline using a linear mixed model, with adjustment for possible confounders such as HIV viral load and hepatitis C antibodies.
Among 284 HIV-positive ART naïve patients, the majority were male (56%) with a history of IDU (79% among men). People with a history of IDU had a statistically significant faster decline in CD4 cells (p<0.001). Based on our data, patients with a history of IDU would have an average 33% decline in CD4 cells after one year without ART, compared with a 22% decline among non-users. At two years, the decline would average 66 and 40%, respectively. No other factor was significantly associated with CD4 cell decline.
We show that a history of IDU is associated with a more rapid CD4 cell natural decline among HIV-positive individuals in Indonesia. These findings have implications for monitoring ART naïve patients with a history of IDU and for starting ART in this group.
通过注射吸毒感染人类免疫缺陷病毒（HIV）的患者其自然病程是否有所不同尚不清楚，且低收入或中等收入国家尚未发表相关数据。我们在印度尼西亚的一个城市队列中研究了这个问题，该国正经历着由注射吸毒强烈驱动的快速增长的HIV疫情。
本研究纳入了所有在开始抗逆转录病毒治疗（ART）前至少有两次后续CD4细胞计数的未接受过ART的HIV阳性患者。我们使用线性混合模型研究了注射吸毒与CD4细胞下降之间的关联，并对可能的混杂因素如HIV病毒载量和丙型肝炎抗体进行了调整。
在284例未接受过ART的HIV阳性患者中，大多数为男性（56%），有注射吸毒史（男性中占79%）。有注射吸毒史的人CD4细胞下降在统计学上显著更快（p<0.001）。根据我们的数据，有注射吸毒史的患者在未接受ART的情况下，一年后CD4细胞平均下降33%，而非注射吸毒者为22%。两年时，下降率分别平均为66%和40%。没有其他因素与CD4细胞下降显著相关。
我们表明，在印度尼西亚，有注射吸毒史与HIV阳性个体中CD4细胞自然下降更快有关。这些发现对监测有注射吸毒史的未接受ART的患者以及该群体开始ART具有重要意义。
