Gambaran Kegagalan Perbaikan CD4 Pasien Koinfeksi TB-HIV Berdasarkan Jarak Waktu Pemberian Antiretroviral Pasca Obat Anti Tuberkulosis di Rumah Sakit Penyakit Infeksi (RSPI) Prof. Dr. Sulianti Saroso

NFN Musdalifah, Ratna Djuwita, Adria Rusli, Mondastri Korib

Abstract


Abstrak
Latarbelakang : Memulai terapi Antiretroviral (ARV) lebih awal berisiko menimbulkan interaksi Obat Anti TB (OAT) dengan ARV, efek samping obat, keracunan akibat obat, tantangan kepatuhan minum obat dan terjadinya Immune Reconstitution Inflammatory Syndrome (IRIS).
Metode : Penelitian ini menggunakan design penelitian kohort restrospektif dengan follow-up selama satu setengah tahun. Penelitian dilaksanakan di Rumah Sakit Penyakit Infeksi (RSPI) Prof. Dr. Sulianti Saroso Tahun 2016. Populasi studi adalah pasien Ko-infeksi TB-HIV yang naive ART dan tercatat pada rekam medis periode Januari 2010 - November 2014. Data pasien diperoleh dari rekam medis pasien dengan kriteria inklusi sampel adalah pasien usia ≥15 tahun, mendapat OAT minimal 2 minggu sebelum ART dimulai, dan memiliki data hasil pemeriksaan CD4 sebanyak dua kali dengan total sampel sebanyak 164 orang.
Hasil : Probabilias kumulatif kegagalan perbaikan CD4 pasien ko-infeksi TB-HIV sebesar 14,43%. Hazard rate kegagalan perbaikan CD4 pada pasien yang memulai terapi ARV 2-8 minggu setelah OAT dibandingkan dengan yang menunda terapi ARV 8 minggu setelah OAT masing-masing 767 per 10.000 orang tahun dan 447 per 10.000 orang tahun (p=0,266).
Kesimpulan : Hazard rate kegagalan perbaikan CD4 pada pasien yang memulai terapi ARV 2-8 minggu setelah OAT lebih tinggi dibandingkan dengan hazard rate pada pasien yang menunda terapi ARV 8 minggu setelah OAT.

 

Abstract
Background : Starting Antiretroviral Treatment (ART) earlier was assosiated to pharmacologic interactions, side effect, high pill burden, treatment interruption, and Immune Reconstitution Inflammatory Syndrome (IRIS).
Methods : This study used cohort restrospective design with one and half year time to follow up. This study was conducted from May to June 2016 at Infectious Disease Hospital Sulianti Saroso. Study population were TB-HIV coinfected patients, noted as a naive ART patient in medical records from january

2010-november 2014. A total 164 patients ≥ 15 years old, had ATT 2 weeks before ART and had minimum 2 CD4 sell count laboratorium test results.
Result : The cumulative probability of CD4 response failure among TB-HIV co-infected patients was 14,43%. Hazard rate of CD4 response failure was 767 per 10.000 person year in early ART (2-8 weeks after OAT) versus 474 per 10.000 person year in delayed ART (8 weeks after OAT) (p=0,266).
Conclusion : Hazard CD4 repair failure rate in patients who started ARV therapy 2-8 weeks after OAT higher than the hazard rate in patients who deferred antiretroviral therapy 8 weeks after OAT.


Keywords


Ko-infeksi TB-HIV, ART, kegagalan perbaikan CD4

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References


World Health Organization. Global summary of the AIDS Epidemic. [Internet] 2015 [cited 08 April 2016]. Available from: http://www.who.int/hiv/data/epi_core_july2015.png

Kementerian Kesehatan Republik Indonesia. Petunjuk Teknis Tata Laksana Klinis Ko-infeksi TB-HIV. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan. Jakarta ; 2012

Kwan KC and Ernst DJ. HIV and Tuberculosis: a Deadly Human Syndemic. Clinical Microbiology Review. Apr. 2011, p.351-376. [Internet] 2011 [cited 08 April 2016]. Available from :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122491/pdf/zcm351.pdf.

World Health Organization. TB-HIV Indonesia ; Update, 2014. . [Internet] 2011 [cited 02 Februari 2016]. http://www.searo.who.int/indonesia/topics/tbindonesiaupdate2014/en/

Velasco M et al. Effect of Simultaneous Use of Highly Active Antiretroviral Therapy on Survival of HIV Patients With Tuberculosis. 2009. J Acquir Immune Defic Syndr _ Volume 50, Number 2, February 1, 2009. [Internet] 2009[cited 13 Oktober 2015].

World Health Organisation. Guideline on When to Start Antiretroviral Theraphy and on Pre-Exposure Prophylaxis for HIV. [Internet] 2015[cited 03 Maret 2016]. Available from: http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf

Naidoo K, Baxter C, Karim SSA. When to start antiretroviral therapy during tuberculosis treatment. Curr Opin Infect Dis. 2013 February ; 26(1): 35–42. doi:10.1097/QCO.0b013e32835ba8f9. [internet] 2013 (cited 08 Oktober 2015). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616247/pdf/nihms448558.pdf

Sinha S, et al. Early versus delayed initiation on antiretroviral therapy for indian HIV infected individual with tuberculosis on antituberculosis treatment. BMC infectius disease 2012, 12:168. [Internet] 2012 [cited 28 Februari 2016]. Available from: http://www.biomedcentral.com/1471-2334/12/1689. Yirdaw KD and Hattingh S. Prevalence and Predictors of Immunological. Failure among HIV Patients on HAART in Southern Ethiopia. PLOS ONE | DOI:10.1371/journal.pone.0125826. [Internet] 2015. [cited 04 januari 2016] Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125826.

Assefa, A., gelawa B, Getnet G, and Yitayew G. The Effect of Incident Tuberculosis on Immunological Response of HIV Patients on Highly Active Antiretroviral Therapy at Gondar University Hospital, Northwest Ethiopia: A Retrospective Follow-up Study. BMC Infectious Disease 2014, 14:468 [Internet] 2014 [cited 01 April 2016] http://www.biomedcentral.com/1471-2334/14/468

World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating HIV infection. [Internet] 2013 [cited 01 April 2016]. Available from: http://www.who.int/hiv/pub/guidelines/arv2013/download/en/index.html

Elwood M. Critical Appraisal of Epidemilogical Studies and Clinical Trials. Oxford: Oxford University Press; 2007.

Maemun S. 2015. Pengaruh Waktu Awal Pengobatan Antiretroviral (ARV) Terhadap Ketahanan Hidup Satu Tahun Pasien Ko-infeksi TB-HIV di Rumah Sakit Penyakit Infeksi Prof. Dr. Sulianti Saroso Periode Januari 2011-Mei 2014. [Tesis] Depok. Fakultas Kesehatan Masyarakat, Universitas Indonesia, 2015.




DOI: https://doi.org/10.32667/ijid.v3i2.31

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