Response to first-line antiretroviral treatment among human immunodeficiency virus-infected patients with and without a history of injecting drug use in Indonesia
Article first published online: 10 MAR 2010
© 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction
Volume 105, Issue 6, pages 1055–1061, June 2010
How to Cite
Wisaksana, R., Indrati, A. K., Fibriani, A., Rogayah, E., Sudjana, P., Djajakusumah, T. S., Sumantri, R., Alisjahbana, B., Van Der Ven, A. and Van Crevel, R. (2010), Response to first-line antiretroviral treatment among human immunodeficiency virus-infected patients with and without a history of injecting drug use in Indonesia. Addiction, 105: 1055–1061. doi: 10.1111/j.1360-0443.2010.02898.x
- Issue published online: 6 MAY 2010
- Article first published online: 10 MAR 2010
- Submitted 25 August 2009; initial review completed 2 November 2009; final version accepted 24 November 2009
- Antiretroviral therapy;
- highly active;
- HIV infections;
- substance abuse;
- treatment outcome
Background There is a common belief that injecting drug use (IDU) is associated with lower uptake, retention and success of antiretroviral treatment (ART) in human immunodeficiency virus (HIV)-infected patients. We examined this in an Indonesian setting, where IDU is the main risk factor for HIV infection.
Methods Patient characteristics and response to ART were recorded for all patients diagnosed with HIV infection in the referral hospital for West Java (40 million people). Kaplan–Meier estimates and Cox's regression were used to compare mortality, loss to follow-up and virological failure between patients with and without a history of IDU.
Result A total of 773 adult HIV patients (81.9% IDUs) presented between January 1996 and April 2008. IDUs had a median CD4 cell count of 33 [interquartile ratio (IQR), 12–111] cells/mm3 compared to 84 (IQR, 28–224) cells/mm3 in non-IDUs. Among patients with a history of IDU, 87.7% were coinfected with hepatitis C (HCV). Mortality was associated strongly with CD4 count; after 6 months of ART, 18.3, 20.3, 7.1 and 0.7% of patients with CD4 cell counts <25, 25–99, 100–199, respectively, ≥200/mm3 had died (P < 0.0001). Mortality [adjusted for CD4; hazard ratio (HR) = 0.65; 95% confidence interval (CI) 0.35–1.23], loss to follow-up (HR = 0.85, 95% CI 0.51–1.41) and virological failure (HR = 0.47, 95% CI 0.19–1.13) were not significantly different in IDUs and non-IDUs.
Conclusion Intravenous drug users (IDUs) in Indonesia with HIV/acquired immune deficiency syndrome tend to have more advanced disease but respond similarly to non-IDUs to antiretroviral therapy.