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Observational Study
. 2025 Jan 20;25(1):87.
doi: 10.1186/s12879-024-10354-8.

A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality

Tuti P Merati  1 , Evy Yunihastuti  2 , Rudi Wisaksana  3 , Nia Kurniati  2 , Dona Arlinda  4   5 , Muhammad Karyana  6   7 , Nugroho H Susanto  6 , Dewi Lokida  6 , Herman Kosasih  6 , Aly Diana  6 , Lois E Bang  6 , Melinda Setiyaningrum  6 , Desrinawati M Amin  8 , Eppy Eppy  9 , Wiwit A S N Cahyawati  10 , Emon W Danudirgo  11 , I Made Gede Darmaja  12 , Nur Farhanah  13 , Carta A Gunawan  14 , Usman Hadi  15 , Kurnia F Jamil  16 , Sudirman Katu  17 , Tambar Kembaren  18 , I Gede Rai Kosa  19 , Danang L Norosingomurti  20 , Asep Purnama  21 , Ida S Laksanawati  22 , Adria Rusli  8 , I Ketut Agus Somia  23 , Yanri W Subronto  24 , Ivan L Toruan  25 , Renee Ridzon  26 , C Jason Liang  26 , Aaron T Neal  26 , Ray Y Chen  26 ; INA-PROACTIVE Study Group
Collaborators, Affiliations
Observational Study

A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality

Tuti P Merati et al. BMC Infect Dis. .

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.

Keywords: Adult cohort; HIV; Indonesia; Mortality; Risk factors; Viremia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was reviewed and approved by the central Ethics Committee of the National Institute of Health Research and Development (NIHRD) (LB.02.01/2/KE.012/2018) and the Ethics Committees of 2 study sites requiring additional reviews. All participants or their guardians signed informed consent to participate in the study, with minors signing assent as appropriate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map of INA-PROACTIVE study sites
Fig. 2
Fig. 2
STROBE diagram of patient selection for analysis
Fig. 3
Fig. 3
Kaplan–Meier plot comparing all-cause mortality over one year among study participants grouped by HIV viral load category
See this image and copyright information in PMC

References

    1. Indonesia, World Health Organization, editors. Review of the health sector response to HIV and AIDS in Indonesia, 2007. New Delhi: World Health Organization, Regional Office for South-East Asia; 2007. Available from: https://iris.who.int/handle/10665/205869.
    1. UNAIDS. Country Factsheets Indonesia 2022. 2022. Available from: https://www.unaids.org/en/regionscountries/countries/indonesia. Cited 2022 Dec 3.
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