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

Merati, Tuti Parwati and Yunihastuti, Evy and Wisaksana, Rudi and Kurniati, Nia and Arlinda, Dona and Karyana, Muhammad and Susanto, Nugroho Harry and Lokida, Dewi and Kosasih, Herman and Diana, Aly and Bang, Lois Eirene and Setiyaningrum, Melinda and Amin, Desrinawati Muhammad and Eppy, Eppy and Cahyawati, Wiwit Agung Sri Nur and Danudirgo, Emon Winardi and Darmaja, I. Made Gede and Farhanah, Nur and Gunawan, Carta Agrawanto and Hadi, Usman and Jamil, Kurnia Fitri and Katu, Sudirman and Kembaren, Tambar and Kosa, I. Gede Rai and Norosingomurti, Danang Legowo and Purnama, Asep Bahtiar and Laksanawati, Ida Safitri and Rusli, Adria and Ketut Agus Somia, I. Ketut Agus and Subronto, Yanri Wijayanti and Toruan, Ivan Lumban and Ridzon, Renée and Liang, C. Jason and Neal, Aaron T. and Chen, Ray Y. and Watkins, Katie and Perodin, Jacqueline and Grue, Louis and Lau, Chuen Yen and Wulan, Wahyu Nawang and Agusta, Virtania Meirina and Saraswati, Tiya and Sari, Rizki Amalia and Mukti, Restu Amalia and Lukman, Nurhayati and Hanum, Nur Latifah and Ariqa, Nada and Siahaan, Meity and Pranata, IWayan Wayan Adi and Rusman, Eka Windari and Butarbutar, Deni Pepy Rentina and Junior, Chandra Ilham El Anwary and Naysilla, Adhella Menur and Yuanti, Maria Yupina and Tolok, Stefani Marwah and Koli, Kurniawati Handayani and Mathilde, Fransiska and Riawan, Ulul Azmiyah and Sari, Putri Nur Indah and Nugroho, Dwi Kurniawan and Nara, Mario Bernardinus Realino and Ayer, Martha Magdalena and Sunarti, null and Swastika, Widya Amalia and Emma, Nani and Yanti, Noor Ridha and Sembiring, Justina Berry and Purwaningsih, Immaculata and Darmaja, IMade Gede and Suyanti, Emy and Sudaryanto, null and Herlina, null and Rahmawati, Ike Nesdia and Vebrina, Redha and Susanti, Wiwi Endang and Halim, Handoko and Nugroho, Muchamad Budi and Arfajah, null and Firbria, Ella and Husna, Nurul and Muslim, null and Novita, Ika and Azhar, Muhammad Abrar and Mutiawati, Vivi Keumala and Safri, Mulya and Achmaddany, Ady and Mukano, Nursiah and Heniastuti, null and Palondongan, Monika Lestari and Prasetya, Edwin and Agustyana, Andini and Hendra, null and Wahyunie, Sri and Ang, Sunarto and Sitorus, Friska Ernita and Sulastri, Diana and Mutamimah, null and Wullur, Winny Wangun Lestari and Hardoni, Glegery Putri and Tanzil, Francisca Lianiwati (2025) A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality. BMC Infectious Diseases, 25 (1): 87. ISSN 14712334

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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. © The Author(s) 2025.

Item Type: Article
Additional Information: Cited by: 1; All Open Access; Gold Open Access; Green Accepted Open Access; Green Open Access
Uncontrolled Keywords: abacavir; darunavir plus ritonavir; dolutegravir; efavirenz; emtricitabine; etravirine; lamivudine; nevirapine; raltegravir; tenofovir; zidovudine; anti human immunodeficiency virus agent; adult; all cause mortality; antiretroviral therapy; Article; body mass; CD4 lymphocyte count; cohort analysis; coinfection; comorbidity; controlled study; female; hazard ratio; Hepatitis B virus; Hepatitis C virus; human; Human immunodeficiency virus infection; immunosuppressive treatment; incidence; Indonesia; male; mortality; observational study; pneumonia; prospective study; randomized controlled trial; risk factor; sensitivity analysis; sociodemographics; toxoplasmosis; underweight; viremia; virus load; adolescent; clinical trial; drug therapy; epidemiology; middle aged; multicenter study; virology; young adult; Adolescent; Adult; Anti-HIV Agents; Coinfection; Female; HIV Infections; Humans; Male; Middle Aged; Prospective Studies; Risk Factors; Viral Load; Young Adult
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine, Public Health and Nursing > Non Surgical Divisions
Depositing User: Ani PURWANDARI
Date Deposited: 24 Feb 2026 05:31
Last Modified: 24 Feb 2026 05:31
URI: https://ir.lib.ugm.ac.id/id/eprint/25798

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