title: Injecting drug use is associated with a more rapid CD4 cell decline among treatment naïve HIV-positive patients in Indonesia.
abstract: BACKGROUND
  It remains unclear whether the natural course of human immunodeficiency virus (HIV) differs in subjects infected through injecting drug use (IDU) and no data have been published from low- or middle-income countries. We addressed this question in an urban cohort in Indonesia, which is experiencing a rapidly growing HIV epidemic strongly driven by IDU.
  
  
  METHODS
  All antiretroviral treatment (ART) naïve HIV-positive patients who had at least two subsequent CD4 cell counts available before starting ART were included in this study. We examined the association between IDU and CD4 cell decline using a linear mixed model, with adjustment for possible confounders such as HIV viral load and hepatitis C antibodies.
  
  
  RESULTS
  Among 284 HIV-positive ART naïve patients, the majority were male (56%) with a history of IDU (79% among men). People with a history of IDU had a statistically significant faster decline in CD4 cells (p<0.001). Based on our data, patients with a history of IDU would have an average 33% decline in CD4 cells after one year without ART, compared with a 22% decline among non-users. At two years, the decline would average 66 and 40%, respectively. No other factor was significantly associated with CD4 cell decline.
  
  
  CONCLUSIONS
  We show that a history of IDU is associated with a more rapid CD4 cell natural decline among HIV-positive individuals in Indonesia. These findings have implications for monitoring ART naïve patients with a history of IDU and for starting ART in this group.
authors.affiliation: Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Hinta
authors.initials: H
authors.lastname: Meijerink
authors.affiliation: Department of Internal Medicine, Medical Faculty, Universitas Padjadjaran and Hasan Sadikin Hospital, Bandung, Indonesia.
authors.forename: Rudi
authors.initials: R
authors.lastname: Wisaksana
authors.affiliation: Department of Psychiatry Medical Faculty, Universitas Padjadjaran and Hasan Sadikin Hospital, Bandung, Indonesia.
authors.forename: Shelly
authors.initials: S
authors.lastname: Iskandar
authors.affiliation: Department of Internal Medicine, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: den Heijer
authors.affiliation: Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Andre J A M
authors.initials: AJ
authors.lastname: van der Ven
authors.affiliation: Department of Internal Medicine, Medical Faculty, Universitas Padjadjaran and Hasan Sadikin Hospital, Bandung, Indonesia.
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
authors.affiliation: Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; reinout.vancrevel@radboudumc.nl.
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000276:immunology
keywords: CD4-positive T-Lymphocytes; Indonesia; cohort studies; human immunodeficiency virus; injecting drug use (IDU)