Periode Waktu Inisiasi Anti-Retroviral Terapi (ART) Berhubungan dengan Perbedaan Outcome dan Tingkat Kadar CD4 pada Kasus HIV Positif
Abstract
Early ART (Anti Retroviral Therapy) treatment at higher CD4 levels is believed to provide better outcomes.This study aims to determine the differences in outcomes and levels of CD4 levels based on the initiation periodof ART in HIV positive patients. This is a retrospective study, using secondary data to see differences in outcomes(CD4, morbidity, morbidity, lost to follow-up) of patients based on time-span status of ART initiation. The studypopulation was all HIV-positive patients who were or had undergone antiretroviral therapy in Denpasar City. Atotal of 312 patients were included in the study according to the criteria. The results showed that the proportionof subjects who had a CD4 cell rise of only 0-99sel/mm3 tended to be greater in the group who started ART morethan 12 weeks compared to those who started ART 12 weeks down (44.7% vs 36.7%). Vice versa, the proportionof subjects who had a CD4 increase ≥100 cells/mm3 was greater in the ART initiation group ≤12 weeks (73.3% vs55.3%) p=0.046. The proportion of subjects who died and lost to follow up was greater in the subjects who startedART over 12 weeks than the opposite (respectively 11% and 24.2% vs 5% and 12.7%, p=0.003). Significant differenceswere also seen, the proportion of subjects who were still on HAART was greater in the group of subjects whoinitiated HAART ≤12 weeks (64.8% vs 82.4%, p=0.003).
References
1. Global HIV and AIDS Statistics. Avert[Web Page]. 2017; [Diakses 23 Maret 2018]. Available at: https://www.avert.org/global-hiv-and-aids-statistics.
2. Kementerian Kesehatan Republik Indonesia, Direktorat Jenderal Pencegahan dan Pengendalian Penyakit. Laporan Perkembangan HIV-AIDS & Penyakit Infeksi Menular Seksual (PIMS) Triwulan I Tahun 2017. Jakarta : Kementrian Kesehatan RI; 2017.
3. UNAIDS. Indonesia. 2018; [Diakses. 22 Maret 2018]. Available at: http://www.unaids.org/en/regionscountries/countries/indonesia.
4. Dinas Kesehatan Provinsi Bali. Profil Kesehatan Dinas Kesehatan Provinsi Bali 2016. Bali: Dinas Kesehatan Provinsi Bali; 2017.
5. Nachega JB, Uthman OA, Del Rio C, Mugavero MJ, Rees H, Mills EJ. Addressing the Achilles' Heel in the HIV Care Continuum for the Success of A Test-and-treat Strategy to Achieve an AIDS-free Generation. Clinical Infectious Diseases. 2014;59(suppl_1):S21-S7.
6. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as A Strategy for Elimination Of HIV Transmission: A Mathematical model. The Lancet. 2009;373(9657):48-57.
7. Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of Early versus Deferred Antiretroviral Therapy for HIV On Survival. New England Journal of Medicine. 2009;360(18):1815-26.
8. World Health Organization. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV, web supplement: annex 2: Evidence to Decision-making Tables and Supporting Evidence. World Health Organization. 2015.
9. World Health Organization. HIVAdolescents: Guidance for HIV Testing and Counselling and Care for Adolescents Living with HIV: Recommendations for a Public Health Approach and Considerations for Policy-makers and Managers. Geneva: WHO. 2013.
10. Lamb MR, Fayorsey R, Nuwagaba-Biribonwoha H, Viola V, Mutabazi V, Alwar T, et al. High Attrition Before and After ART Initiation Among Youth (15–24 Years of Age) Enrolled in HIV Care. AIDS. 2014; 28(4):559.
11. Koech E, Teasdale CA, Wang C, Fayorsey R, Alwar T, Mukui IN, et al. Characteristics and Outcomes of HIV-infected Youth and Young Adolescents Enrolled in HIV Care in Kenya. AIDS. 2014; 28(18):2729.
12. Matyanga C, Takarinda K, Owiti P, Mutasa-Apollo T, Mugurungi O, Buruwe L, et al. Outcomes of Antiretroviral Therapy Among Younger Versus Older Adolescents and Adults in an Urban Clinic, Zimbabwe. Public Health Action. 2016; 6(2):97-104.
13. Anglemyer A, Rutherford GW, Easterbrook PJ, Horvath T, Vitoria M, Jan M, et al. Early Initiation of Antiretroviral Therapy in HIV-infected Adults and Adolescents: A Systematic Review. AIDS. 2014; 28:S105-S18.
14. Schomaker M, Leroy V, Wolfs T, Technau K-G, Renner L, Judd A, et al. Optimal Timing of Antiretroviral Treatment Initiation in HIV-positive Children and Adolescents: A Multiregional Analysis from Southern Africa, West Africa and Europe. International Journal of Epidemiology. 2016; 46(2):453-65.
15. Hutapea HML, Mirino Y, Widiyanti M, Fitriana E, Maladan Y, Oktavian A. Penurunan CD4 Pada ODHA Setelah Terapi ARV Lebih Dari 39 Bulan. Media Kesehatan Masyarakat Indonesia. 2017; 13(3):267-72.
16. Mocroft A, Phillips AN, Gatell J, Ledergerber B, Fisher M, Clumeck N, et al. Normalisation of CD4 Counts in Patients with HIV-1 Infection and Maximum Virological Suppression Who are Taking Combination Antiretroviral Therapy: An Observational Cohort Study. The Lancet. 2007; 370(9585):407-13.
17. Sidebang P. Karakteristik Penderita HIV/AIDS Di Puskesmas Tanjung Morawa Agustus 2006–Mei 2010.
18. Teasdale CA, Wang C, Francois U, Ndahimana JdA, Vincent M, Sahabo R, et al. Time to Initiation of Antiretroviral Therapy among Patients Who are ART Eligible in Rwanda: Improvement Over Time. Journal of Acquired Immune Deficiency Syndromes (1999). 2015; 68(3):314.
19. Rosen S, Fox MP. Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review. PLoS Medicine. 2011; 8(7):e1001056.
20. Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, et al. Loss to Programme between HIV Diagnosis and Initiation of Antiretroviral Therapy in Sub‐Saharan Africa: Systematic Review and Meta‐analysis. Tropical Medicine & International Health. 2012;17(12):1509-20.
21. Hanna DB, Buchacz K, Gebo KA, Hessol NA, Horberg MA, Jacobson LP, et al. Trends and Disparities in Antiretroviral Therapy Initiation and Virologic Suppression among Newly Treatment-Eligible HIV-infected Individuals in North America, 2001–2009. Clinical Infectious Diseases. 2013; 56(8):1174-82.
22. Kayigamba FR, Bakker MI, Fikse H, Mugisha V, Asiimwe A, van der Loeff MFS. Patient Enrolment into HIV Care and Treatment within 90 days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-based Registers. PloS One. 2012; 7(5):e36792.
23. Asfaw A, Ali D, Eticha T, Alemayehu A, Alemayehu M, Kindeya F. CD4 Cell Count Trends after Commencement of Antiretroviral Therapy among HIV-infected Patients in Tigray, Northern Ethiopia: A Retrospective Cross-sectional study. PLoS One. 2015; 10(3):e0122583.
24. Montarroyos UR, Miranda-Filho DB, César CC, Souza WV, Lacerda HR, Albuquerque MdFPM, et al. Factors Related to Changes in CD4+ T-cell Counts Over Time in Patients Living with HIV/AIDS: A Multilevel Analysis. PloS One. 2014; 9(2):e84276.
25. Onoka C, Uzochukwu B, Onwujekwe O, Chukwuka C, Ilozumba J, Onyedum C, et al. Retention and Loss to Follow-up in Antiretroviral Treatment Programmes in Southeast Nigeria. Pathogens and Global Health. 2012; 106(1):46-54.
26. Ssebunya R, Wanyenze RK, Lukolyo H, Mutto M, Kisitu G, Amuge P, et al. Antiretroviral Therapy Initiation Within Seven Days of Enrolment: Outcomes and Time to Undetectable Viral Load among Children at an Urban HIV Clinic in Uganda. BMC Infectious Diseases. 2017; 17(1):439.
27. Sinha S, Shekhar RC, Singh G, Shah N, Ahmad H, Kumar N, et al. Early versus Delayed Initiation of Antiretroviral Therapy for Indian HIV-Infected Individuals with Tuberculosis on Antituberculosis Treatment. BMC Infectious Diseases. 2012; 12(1):168.
28. World Health Organization. Guidelines for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy. Geneva: World Health Organization; 2017.
29. Jourdain G, Le Cœur S, Ngo-Giang-Huong N, Traisathit P, Cressey TR, Fregonese F, et al. Switching HIV Treatment in Adults Based on CD4 Count versus Viral Load Monitoring: A Randomized, Non-inferiority Trial in Thailand. PLoS Medicine. 2013; 10(8):e1001494.
30. Rokhmah D, Khoiron K. Urgensi Perubahan Implementasi Kebijakan dalam Menurunkan IMS, HIV dan AIDS pada Komunitas LSL di Kabupaten Jember. Media Kesehatan Masyarakat Indonesia. 2016; 11(4):210-7.
2. Kementerian Kesehatan Republik Indonesia, Direktorat Jenderal Pencegahan dan Pengendalian Penyakit. Laporan Perkembangan HIV-AIDS & Penyakit Infeksi Menular Seksual (PIMS) Triwulan I Tahun 2017. Jakarta : Kementrian Kesehatan RI; 2017.
3. UNAIDS. Indonesia. 2018; [Diakses. 22 Maret 2018]. Available at: http://www.unaids.org/en/regionscountries/countries/indonesia.
4. Dinas Kesehatan Provinsi Bali. Profil Kesehatan Dinas Kesehatan Provinsi Bali 2016. Bali: Dinas Kesehatan Provinsi Bali; 2017.
5. Nachega JB, Uthman OA, Del Rio C, Mugavero MJ, Rees H, Mills EJ. Addressing the Achilles' Heel in the HIV Care Continuum for the Success of A Test-and-treat Strategy to Achieve an AIDS-free Generation. Clinical Infectious Diseases. 2014;59(suppl_1):S21-S7.
6. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as A Strategy for Elimination Of HIV Transmission: A Mathematical model. The Lancet. 2009;373(9657):48-57.
7. Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of Early versus Deferred Antiretroviral Therapy for HIV On Survival. New England Journal of Medicine. 2009;360(18):1815-26.
8. World Health Organization. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV, web supplement: annex 2: Evidence to Decision-making Tables and Supporting Evidence. World Health Organization. 2015.
9. World Health Organization. HIVAdolescents: Guidance for HIV Testing and Counselling and Care for Adolescents Living with HIV: Recommendations for a Public Health Approach and Considerations for Policy-makers and Managers. Geneva: WHO. 2013.
10. Lamb MR, Fayorsey R, Nuwagaba-Biribonwoha H, Viola V, Mutabazi V, Alwar T, et al. High Attrition Before and After ART Initiation Among Youth (15–24 Years of Age) Enrolled in HIV Care. AIDS. 2014; 28(4):559.
11. Koech E, Teasdale CA, Wang C, Fayorsey R, Alwar T, Mukui IN, et al. Characteristics and Outcomes of HIV-infected Youth and Young Adolescents Enrolled in HIV Care in Kenya. AIDS. 2014; 28(18):2729.
12. Matyanga C, Takarinda K, Owiti P, Mutasa-Apollo T, Mugurungi O, Buruwe L, et al. Outcomes of Antiretroviral Therapy Among Younger Versus Older Adolescents and Adults in an Urban Clinic, Zimbabwe. Public Health Action. 2016; 6(2):97-104.
13. Anglemyer A, Rutherford GW, Easterbrook PJ, Horvath T, Vitoria M, Jan M, et al. Early Initiation of Antiretroviral Therapy in HIV-infected Adults and Adolescents: A Systematic Review. AIDS. 2014; 28:S105-S18.
14. Schomaker M, Leroy V, Wolfs T, Technau K-G, Renner L, Judd A, et al. Optimal Timing of Antiretroviral Treatment Initiation in HIV-positive Children and Adolescents: A Multiregional Analysis from Southern Africa, West Africa and Europe. International Journal of Epidemiology. 2016; 46(2):453-65.
15. Hutapea HML, Mirino Y, Widiyanti M, Fitriana E, Maladan Y, Oktavian A. Penurunan CD4 Pada ODHA Setelah Terapi ARV Lebih Dari 39 Bulan. Media Kesehatan Masyarakat Indonesia. 2017; 13(3):267-72.
16. Mocroft A, Phillips AN, Gatell J, Ledergerber B, Fisher M, Clumeck N, et al. Normalisation of CD4 Counts in Patients with HIV-1 Infection and Maximum Virological Suppression Who are Taking Combination Antiretroviral Therapy: An Observational Cohort Study. The Lancet. 2007; 370(9585):407-13.
17. Sidebang P. Karakteristik Penderita HIV/AIDS Di Puskesmas Tanjung Morawa Agustus 2006–Mei 2010.
18. Teasdale CA, Wang C, Francois U, Ndahimana JdA, Vincent M, Sahabo R, et al. Time to Initiation of Antiretroviral Therapy among Patients Who are ART Eligible in Rwanda: Improvement Over Time. Journal of Acquired Immune Deficiency Syndromes (1999). 2015; 68(3):314.
19. Rosen S, Fox MP. Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review. PLoS Medicine. 2011; 8(7):e1001056.
20. Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, et al. Loss to Programme between HIV Diagnosis and Initiation of Antiretroviral Therapy in Sub‐Saharan Africa: Systematic Review and Meta‐analysis. Tropical Medicine & International Health. 2012;17(12):1509-20.
21. Hanna DB, Buchacz K, Gebo KA, Hessol NA, Horberg MA, Jacobson LP, et al. Trends and Disparities in Antiretroviral Therapy Initiation and Virologic Suppression among Newly Treatment-Eligible HIV-infected Individuals in North America, 2001–2009. Clinical Infectious Diseases. 2013; 56(8):1174-82.
22. Kayigamba FR, Bakker MI, Fikse H, Mugisha V, Asiimwe A, van der Loeff MFS. Patient Enrolment into HIV Care and Treatment within 90 days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-based Registers. PloS One. 2012; 7(5):e36792.
23. Asfaw A, Ali D, Eticha T, Alemayehu A, Alemayehu M, Kindeya F. CD4 Cell Count Trends after Commencement of Antiretroviral Therapy among HIV-infected Patients in Tigray, Northern Ethiopia: A Retrospective Cross-sectional study. PLoS One. 2015; 10(3):e0122583.
24. Montarroyos UR, Miranda-Filho DB, César CC, Souza WV, Lacerda HR, Albuquerque MdFPM, et al. Factors Related to Changes in CD4+ T-cell Counts Over Time in Patients Living with HIV/AIDS: A Multilevel Analysis. PloS One. 2014; 9(2):e84276.
25. Onoka C, Uzochukwu B, Onwujekwe O, Chukwuka C, Ilozumba J, Onyedum C, et al. Retention and Loss to Follow-up in Antiretroviral Treatment Programmes in Southeast Nigeria. Pathogens and Global Health. 2012; 106(1):46-54.
26. Ssebunya R, Wanyenze RK, Lukolyo H, Mutto M, Kisitu G, Amuge P, et al. Antiretroviral Therapy Initiation Within Seven Days of Enrolment: Outcomes and Time to Undetectable Viral Load among Children at an Urban HIV Clinic in Uganda. BMC Infectious Diseases. 2017; 17(1):439.
27. Sinha S, Shekhar RC, Singh G, Shah N, Ahmad H, Kumar N, et al. Early versus Delayed Initiation of Antiretroviral Therapy for Indian HIV-Infected Individuals with Tuberculosis on Antituberculosis Treatment. BMC Infectious Diseases. 2012; 12(1):168.
28. World Health Organization. Guidelines for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy. Geneva: World Health Organization; 2017.
29. Jourdain G, Le Cœur S, Ngo-Giang-Huong N, Traisathit P, Cressey TR, Fregonese F, et al. Switching HIV Treatment in Adults Based on CD4 Count versus Viral Load Monitoring: A Randomized, Non-inferiority Trial in Thailand. PLoS Medicine. 2013; 10(8):e1001494.
30. Rokhmah D, Khoiron K. Urgensi Perubahan Implementasi Kebijakan dalam Menurunkan IMS, HIV dan AIDS pada Komunitas LSL di Kabupaten Jember. Media Kesehatan Masyarakat Indonesia. 2016; 11(4):210-7.
Authors
Putri, W. C. W. S., Sawitri, A. A. S., & Sari, K. A. K. (2018). Periode Waktu Inisiasi Anti-Retroviral Terapi (ART) Berhubungan dengan Perbedaan Outcome dan Tingkat Kadar CD4 pada Kasus HIV Positif. Media Kesehatan Masyarakat Indonesia, 14(3), 217-224. https://doi.org/10.30597/mkmi.v14i3.4123
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