Response to first-line antiretroviral treatment among human immunodeficiency virus-infected patients with and without a history of injecting drug use in Indonesia
Response to first-line antiretroviral treatment among human immunodeficiency virus-infected patients with and without a history of injecting drug use in Indonesia
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DOI：
10.1111/j.1360-0443.2010.02898.x
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发表时间：
2010-06-01
期刊：
影响因子：
6
通讯作者：
van Crevel, Reinout
中科院分区：
文献类型：
--
作者：
Wisaksana, Rudi;Indrati, Agnes K.;van Crevel, Reinout
背景人们普遍认为，注射吸毒（IDU）与人类免疫缺陷病毒（HIV）感染患者抗逆转录病毒治疗（ART）的吸收、保留和成功率较低有关。我们研究了这一点在印度尼西亚的设置，IDU是HIV infection.MethodsPatient的主要危险因素的特点和ART的反应被记录在西爪哇的转诊医院（40万人）诊断为HIV感染的所有患者。Kaplan-Meier估计和考克斯回归被用来比较死亡率，损失后续和病毒学失败的患者和没有IDU.ResultA的历史，共773成人艾滋病患者（81.9% IDUs）之间提出1996年1月至2008年4月。IDUs的中位CD 4细胞计数为33 [四分位数比（IQR），12-111]个细胞/mm 3，而非IDUs为84（IQR，28-224）个细胞/mm 3。在有静脉吸毒史的患者中，87.7%合并丙型肝炎（HCV）感染。死亡率与CD 4细胞计数密切相关; ART治疗6个月后，CD 4细胞计数< 25、25-99、100-199、>= 200/mm 3的患者分别有18.3、20.3、7.1和0.7%死亡（P < 0.0001）。死亡率[校正CD 4;风险比（HR）= 0.65; 95%置信区间（CI）0.35-1.23]，失访（HR = 0.85，95% CI 0.51-1.41）和病毒学失败（HR = 0.47，95%CI 0.19-1.13）在注射吸毒者和非注射吸毒者中没有显著差异。获得性免疫缺陷综合症患者往往病情较重，但对抗逆转录病毒疗法的反应与非注射吸毒者相似。
BackgroundThere 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.MethodsPatient 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.ResultA 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.ConclusionIntravenous 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.