Publikasi HIV - Rudi Wisaksana, dr., SpPD.

Response to first line antiretroviral therapy among HIV-infected patients with and without a history of injecting drug use in Indonesia

Rudi Wisaksana, Agnes K Indrati, Ega Rogayah, Azzania Fibriani, Bachti Alisjahbana, Primal Sudjana, Tony S Djajakusumah, Andre van der Ven, Reinout van Crevel

Background: There is a common belief that injecting drug use (IDU) is associated with lower uptake, retention and success of antiretroviral treatment (ART) in HIV-infected patients. We examined these issues in an Indonesian setting, where IDU is the main risk factor for HIV-infection.

Method: All HIV-infected patients presenting in a referral hospital between 1996 and April 2008 were included in this study. Data were retrieved from medical records, and starting January 2007 systematic questionnaires and blood examination were conducted prospectively. Clinical presentation and treatment response were compared between patients with and without a history of IDU.

Result: Among 773 adult HIV patients, 81.9% had a history of IDU. Patients with a history of IDU presented with a lower CD4-cell (median 33 vs. 84 cells/mm³)and a high prevalence of HCV-infection (87.8%). Uptake and adherence to ART were not different between IDUs and non-IDUs. IDUs and non-IDUs showed similar mortality andloss to follow-up (figure). After a median of 20 months ART, virological failure was detected in 12.1% of IDUs and 15.8% of non-IDUs (p=0.524).  

Conclusion: These data are the first systematic evaluation of first line ART in Indonesia. Many HIV-patients in this setting have a history of IDU, which is associated with more advanced HIV-AIDS, but not withreduced uptake, retention or success of ART.