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Introduction: Injecting drug use (IDU) is associated with tuberculosis but few data are available from low‐income settings. We examined IDU in relation to active and latent tuberculosis (LTBI) among HIV‐positive individuals in Indonesia, which has a high burden of tuberculosis and a rapidly growing HIV epidemic strongly driven by IDU. Methods: Active tuberculosis was measured prospectively among 1900 consecutive antiretroviral treatment (ART)‐naïve adult patients entering care in a clinic in West Java. Prevalence of LTBI was determined cross‐sectionally in a subset of 518 ART‐experienced patients using an interferon‐gamma release assay. Results: Patients with a history of IDU (53.1%) more often reported a history of tuberculosis treatment (34.8% vs. 21.9%, p Conclusions: HIV‐positive individuals with a history of IDU in Indonesia have more active tuberculosis, with similar rates of LTBI. Within the HIV clinic, LTBI screening and isoniazid preventive therapy may be prioritized to patients with a history of IDU., Introduction Tuberculosis is a major global health problem, ranking as the second leading cause of death from an infectious disease [1]. Individuals who are more often exposed to Mycobacterium tuberculosis, [...]

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 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., Introduction Injecting drug use (IDU) is responsible for human immunodeficiency virus (HIV) infections in 10% of all cases worldwide, and 30% of cases outside Africa [1]. IDU is not only [...]

Introduction: Previous studies, mostly from Africa, have shown that serum cryptococcal antigenemia may precede the development of cryptococcal meningitis and early death among patients with advanced HIV infection. We examined cryptococcal antigenemia as a risk factor for HIV‐associated mortality in Indonesia, which is experiencing a rapidly growing HIV epidemic. Methods: We included ART‐naïve HIV patients with a CD4 cell count below 100 cells/μL and no signs of meningitis in an outpatient HIV clinic in Bandung, West Java, Indonesia. Baseline clinical data and follow‐up were retrieved from a prospective database, and cryptococcal antigen was measured in stored serum samples using a semiquantitative lateral flow assay. Cox regression analysis was used to identify factors related to mortality. Results: Among 810 patients (median CD4 cell count 22), 58 (7.1%) had a positive cryptococcal antigen test with a median titre of 1:80 (range: 1:1 to 1:2560). Cryptococcal antigenemia at baseline was strongly associated with the development of cryptococcal meningitis and early death and loss to follow‐up. After one year, both death (22.4% vs. 11.6%; p=0.016; adjusted HR 2.19; 95% CI 1.78–4.06) and the combined endpoint of death or loss to follow‐up (67.2% vs. 40.4%; p Conclusions: Cryptococcal antigenemia is common and clinically relevant among patients with advanced HIV in this setting. Routine screening for cryptococcal antigen followed by lumbar puncture and pre‐emptive antifungal treatment for those who are positive may help in reducing early mortality., Introduction Cryptococcal meningitis is a major cause of subacute meningitis and death in patients with advanced HIV infection, affecting an estimated one million people each year, especially in sub‐Saharan Africa [...]