印度尼西亚HIV感染的前瞻性观察队列研究：基线特征与一年死亡率
A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality.
作者信息
Merati Tuti P, Yunihastuti Evy, Wisaksana Rudi, Kurniati Nia, Arlinda Dona, Karyana Muhammad, Susanto Nugroho H, Lokida Dewi, Kosasih Herman, Diana Aly, Bang Lois E, Setiyaningrum Melinda, Amin Desrinawati M, Eppy Eppy, Cahyawati Wiwit A S N, Danudirgo Emon W, Darmaja I Made Gede, Farhanah Nur, Gunawan Carta A, Hadi Usman, Jamil Kurnia F, Katu Sudirman, Kembaren Tambar, Kosa I Gede Rai, Norosingomurti Danang L, Purnama Asep, Laksanawati Ida S, Rusli Adria, Somia I Ketut Agus, Subronto Yanri W, Toruan Ivan L, Ridzon Renee, Liang C Jason, Neal Aaron T, Chen Ray Y
机构信息
Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia.
Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Central Jakarta, Indonesia.
出版信息
BMC Infect Dis. 2025 Jan 20;25(1):87. doi: 10.1186/s12879-024-10354-8.
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.
引言
印度尼西亚新诊断出的艾滋病毒感染发病率从2011年的每10万人21例降至2021年的每10万人10例。尽管取得了这一进展，但艾滋病毒感染者（PLWH）中与艾滋病相关的死亡人数却从2010年的3.4%增至2020年的4.8%。确定死亡风险因素可能有助于找出干预领域并降低死亡率。
方法
在印度尼西亚主要岛屿的19家医院开展了一项关于艾滋病毒感染、合并感染和合并症的多中心、前瞻性观察队列研究（INA - PROACTIVE）。该研究在2018年至2020年招募了艾滋病毒感染者，并对他们进行了3年的随访。本次分析纳入了年龄≥18岁且有一年随访数据的艾滋病毒感染者。采用Cox回归来确定入组时与一年死亡率相关的变量。
结果
在该研究分析的4050名艾滋病毒感染者中，68.8%为男性，53.5%通过异性传播感染艾滋病毒，92.4%在入组时接受抗逆转录病毒治疗（ART），72.4%的病毒载量检测不到。一年时，115人（2.8%）死亡。入组时可检测到的病毒血症与死亡率显著相关，且随着病毒载量（VL）类别增加风险上升（与VL<50拷贝/毫升相比，VL为50至<1000拷贝/毫升时，调整后风险比[aHR]为4.47，95%置信区间[CI]：1.47 - 13.56；VL为1000至10000拷贝/毫升时，aHR为7.88，95%CI：2.80 - 22.20；VL>10000拷贝/毫升时，aHR为18.33，95%CI：7.94 - 42.34）。入组时其他与死亡率显著相关的因素包括CD4 +细胞计数<200（aHR为8.02，95%CI：2.69 - 23.86；与≥350相比）、年龄40 - 49岁（aHR为2.19，95%CI 1.23 - 3.87；与18 - 29岁相比）以及体重过轻（aHR为1.84，95%CI：1.18 - 2.85；与正常体重相比）。
结论
在主要有治疗经验的艾滋病毒感染者中，可检测到的病毒血症和持续的免疫抑制与一年死亡率显著相关。本研究强调了实现完全病毒抑制的抗逆转录病毒治疗以及免疫恢复对预防死亡的重要性。
试验注册
临床试验编号：NCT03663920，注册日期：2018年1月4日。
Zotero 插件