Journal of Preventive Medicine and Public Health

Original Articles

Rapid Antiretroviral Therapy Initiation Reduces Mortality Among People Living With HIV in Indonesia: A Retrospective Observational Study: Ifael Yerosias Mauleti, Krishna Adi Wibisana, Djati Prasetio Syamsuridzal, Sri Mulyati, Vivi Lisdawati, Harimat Hendarwan, Ika Saptarini; J Prev Med Public Health. 2025;58(4):360-369. Published online February 22, 2025; DOI: https://doi.org/10.3961/jpmph.24.622

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Objectives
Current recommendations for managing human immunodeficiency virus (HIV) propose that initiating antiretroviral therapy (ART) promptly after diagnosis, regardless of CD4 cell count, may decrease illness and mortality risk. This study aimed to investigate factors associated with reduced mortality, including the time to ART initiation after diagnosis with HIV.
Methods
We conducted a retrospective cohort study using the medical records of 326 people living with human immunodeficiency virus (PLHIV) aged 18 years or older who initiated ART at a tertiary hospital between January 2018 and December 2022. We employed Cox regression models to estimate survival and identify mortality predictors, considering variables with p-values less than 0.05 as statistically significant.
Results
From 2018 to 2022, 19.9% of PLHIV initiated ART within 7 days of diagnosis, and 57 participants died. The final multivariable Cox proportional hazards model indicated that earlier ART initiation significantly reduced mortality risk compared with starting ART more than 60 days after diagnosis, with adjusted hazard ratios of 0.36 for initiation within 7 days and 0.42 for initiation between 8 days and 60 days. Additional characteristics associated with reduced mortality risk included a CD4 count above 200 cells/mm 3 before ART initiation, a lower World Health Organization clinical stage, and tuberculosis post-exposure prophylaxis.
Conclusions
Earlier ART initiation significantly lowered mortality rates. Furthermore, a pre-ART CD4 count above 200 cells/mm³, a lower clinical stage, and tuberculosis preventive therapy were associated with reduced mortality risk among PLHIV. Future studies should investigate additional predictors of mortality within a prospective cohort study framework.

Summary

Key Message
In a retrospective cohort of 326 people living with HIV in Jakarta, Indonesia, rapid ART initiation within 7 days of diagnosis reduced mortality by 64% compared to initiation after 60 days (aHR 0.36; 95% CI 0.14–0.93). Initiating ART between 8 and 60 days conferred a 58% reduction in mortality risk (aHR 0.42; 95% CI 0.22–0.81). Additionally, pre-ART CD4 counts >200 cells/mm³, lower WHO clinical stage, and receipt of TB post-exposure prophylaxis independently predicted improved survival.

Citations

Citations to this article as recorded by

Marginal structural Cox model for estimating the effect of Chinese medicine on the survival of people living with HIV: a 17-year real-world retrospective cohort study
Wanqi Pan, Qianlei Xu, Yanmin Ma, Liran Xu, Huangchao Jia, Dongli Wang, Keying Zhu, Miao Zhang, Juan Wang, Huijun Guo, Yantao Jin
Frontiers in Public Health.2025;[Epub] CrossRef

Factors Associated With Long-term Retention in Antiretroviral Therapy Among People Living With HIV: Evidence From a Tertiary Hospital in Jakarta, Indonesia: Ifael Yerosias Mauleti, Krishna Adi Wibisana, Djati Prasetio Syamsuridzal, Sri Mulyati, Vivi Lisdawati, Ika Saptarini, Nurhayati , Armedy Ronny Hasugian, Harimat Hendarwan; J Prev Med Public Health. 2024;57(3):252-259. Published online April 30, 2024; DOI: https://doi.org/10.3961/jpmph.23.512

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Abstract Summary PDF Supplementary Material

Objectives
This study investigated factors associated with the retention of people living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART) during the first 3 years of treatment.
Methods
A retrospective study using electronic health records was conducted at a tertiary hospital in Jakarta, Indonesia. Adult HIV-positive patients who started ART from 2010 until 2020 were included. A binary logistic regression model was used to identify factors associated with ART retention in the first 3 years.
Results
In total, 535 respondents were included in the analysis. The ART retention rates for the first, second, and third years were 83.7%, 79.1%, and 77.2%, respectively. The multivariate analysis revealed a negative association between CD4 count when starting ART and retention. Patients with CD4 counts >200 cells/mL were 0.65 times less likely to have good retention than those with CD4 counts ≤200 cells/mL. The year of starting ART was also significantly associated with retention. Patients who started ART in 2010-2013 or 2014-2016 were less likely to have good retention than those who started ART in 2017-2020, with adjusted odds ratios of 0.52 and 0.40, respectively. Patients who received efavirenz-based therapy were 1.69 times more likely to have good retention than those who received nevirapine (95% confidence interval, 1.05 to 2.72).
Conclusions
Our study revealed a decline in ART retention in the third year. The CD4 count, year of enrollment, and an efavirenz-based regimen were significantly associated with retention. Patient engagement has long been a priority in HIV programs, with interventions being implemented to address this issue.

Summary

Key Message
The administration of antiretroviral therapy to HIV patients has resulted in increased rates of survival, enhanced quality of life, and less transmission of the virus. Nevertheless, a negative correlation exists between the length of antiretroviral therapy and patient retention in care. Our study used data from a tertiary hospital and indicated a decrease in the retention rate of antiretroviral therapy over the third year. Retention was associated with the CD4 count, year of enrollment, and the use of an efavirenz-based treatment. Emphasizing patient engagement has been a longstanding focus in HIV programs, with initiatives being implemented to tackle this matter.

Citations

Citations to this article as recorded by

Functional status as a predictor of loss to follow-up among people living with HIV on antiretroviral therapy in Tangerang District, Indonesia
Nata Pratama Hardjo Lugito, Maria Irawati Simanjuntak, Stevent Sumantri, Yohan Kho, Sherina Kosayuz, Raenen Liauw
BMC Infectious Diseases.2025;[Epub] CrossRef
Prevalence and trends of cigarette smoking among adults with HIV infection compared with the general population in Korea
Boyoung Park, Yoonyoung Jang, Taehwa Kim, Yunsu Choi, Kyoung Hwan Ahn, Jung Ho Kim, Hye Seong, Jun Yong Choi, Hyo Youl Kim, Joon Young Song, Shin-Woo Kim, Hee Jung Choi, Dae Won Park, Young Kyung Yoon, Sang Il Kim
Epidemiology and Health.2024; 46: e2024097. CrossRef

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