Abstract
BackgroundPapua Province, Indonesia is experiencing an on-going epidemic of Human Immunodeficiency Virus (HIV) infection, with an estimated 9-fold greater prevalence than the overall national rate. This study reviewed the treatment outcomes of an HIV-infected cohort on Antiretroviral Therapy (ART) and the predictors in terms of immunological recovery and virological response.MethodsART-naïve individuals in a workplace HIV program in southern Papua were retrospectively analyzed. Patients were assessed at 6, 12 and 36 months after ART initiation for treatment outcomes, and risk factors for virological suppression (viral load (VL) <1,000 copies/ml), poor immune response (CD4 <200 cells/mm3) and immunological failure (CD4 <100 cells/ mm3) after at least 6 months on ART, using a longitudinal Generalized Estimating Equations multivariate model.ResultsAssessment of 105 patients were included in the final analysis with a median age of 34 years, 88% male, median baseline CD4 236 cells/ mm3, and VL 179,000 copies/ml. There were 74, 73, and 39 patients at 6, 12, and 36 months follow-up, respectively, with 5 deaths over the entire period. For the three observation periods, 68, 80, and 75% of patents achieved virological suppression, poor immune responders decreased from 15, 16 to 10%, whilst 15, 16, 10% met the immunological failure criteria, respectively. Using multivariate analysis, the independent predictor for viral suppression at 12 and 36 months was ≥1 log decrease in VL at 6 months (OR 19.25, p<0.001). Higher baseline CD4 was significantly correlated with better immunological outcomes, and lower likelihood of experiencing immunological failure (p <0.001).ConclusionVirological response at six months after beginning ART is the strongest predictor of viral suppression at 12 and 36 months, and may help in identifying patients needing additional adherence therapy support. Higher baseline CD4 positively affects the immunological outcomes of patients. The findings indicate HIV control programs should prioritize the availability of VL testing and begin ART regardless of CD4 counts in infected patients.
Highlights
Virological monitoring is the preferred method to monitor people living with Human Immunodeficiency Virus (HIV)/ AIDS (PLWHA) on Antiretroviral Therapy (ART) [1]
This study reviewed the treatment outcomes of an HIV-infected cohort on Antiretroviral Therapy (ART) and the predictors in terms of immunological recovery and virological response
The findings indicate HIV control programs should prioritize the availability of Viral load (VL) testing and begin ART regardless of CD4 counts in infected patients
Summary
Virological monitoring is the preferred method to monitor people living with HIV/ AIDS (PLWHA) on Antiretroviral Therapy (ART) [1]. Home to the world’s fourth largest population of more than 260 million people [6], the overall prevalence of HIV in Indonesia is considered relatively low (97.8 per 100,000), with epidemic-level transmission occurring predominantly in Papua Province [7,8]. Papua Province has high HIV prevalence (872.6 per 100,000), nearly nine times greater than the nationwide rate [8,9,10]. Mimika District, a large and sparsely populated area in southern Papua Province, has an estimated HIV prevalence of 1,337 per 100,000; more than thirteen times higher than the national rate [11]. Papua Province, Indonesia is experiencing an on-going epidemic of Human Immunodeficiency Virus (HIV) infection, with an estimated 9-fold greater prevalence than the overall national rate. This study reviewed the treatment outcomes of an HIV-infected cohort on Antiretroviral Therapy (ART) and the predictors in terms of immunological recovery and virological response
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