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Shinta Wulansari
"Latar Belakang. Gangguan kognitif tanpa disadari dapat terjadi pada orang dengan infeksi Human Immunodeficiency Virus (HIV). Insidens ganguan neurokognitif terkait HIV (HIV Associated Neurocognitive Disorders - HAND) pada era anti retroviral (ARV) mencapai 25-38%, dengan prevalensi 37%. Gejala klinis HAND yaitu kelainan kognitif, fungsi motor dan perilaku. Gangguan kognitif sering tidak terdiagnosis sehingga mengganggu aktivitas keseharian. Gangguan kognitif meningkat seiring dengan lamanya pasien HIV dapat bertahan hidup, dan pemakaian ARV jangka panjang berpotensi toksis yang mungkin dapat mempengaruhi tampilan neurokognitif itu sendiri. Perbaikan neurokognitif terkait HIV mulai tampak setelah pengobatan ARV 18 bulan.
Tujuan. Diketahuinya gambaran fungsi kognitif pasien HIV yang sudah dan belum mendapatkan ARV, berdasarkan sebaran umur, jenis kelamin, pendidikan, pekerjaan, CD4, Hepatitis C, anemia dan depresi.
Metode. Merupakan studi potong lintang, melibatkan pasien HIV rawat jalan di Unit Pelayanan Terpadu (UPT) HIV RSCM yang memenuhi kriteria inklusi. Dilakukan pencatatan data dasar pasien, nilai CD4, hemoglobin, depresi berdasarkan skala depresi Hamilton. Dilakukan pemeriksaan fungsi kognitif dengan Trial Making Test A dan B (TMT A dan B), digit span forward dan backward, animal naming, Rey Auditory Verbal Learning Test (RAVLT) dan psikomotor Pegboard.
Hasil. Dari 100 subjek HIV, 50 sudah dan 50 belum ARV. Rata-rata usia subjek 32 tahun, pria sama banyak dengan wanita. Pendidikan terbanyak SMA. Subjek yang bekerja, rerata CD4, dan Hepatitis C reaktif lebih tinggi pada kelompok yang sudah ARV. Anemia lebih banyak pada kelompok subjek belum ARV. Depresi hanya didapat pada 3 subjek. Didapatkan perbedaan bermakna antara fungsi kognitif HIV dengan nilai CD4, pendidikan dan ARV. Gangguan kognitif ringan lebih tinggi pada kelompok belum ARV (48%) dibanding kelompok sudah ARV (18%) dengan perbedaan bermakna pada pemeriksaan bacward digit span, animal naming dan pegboard.
Kesimpulan. Gangguan kognitif ringan terkait HIV lebih tinggi pada kelompok belum ARV, meskipun belum dikeluhkan oleh pasien.

Background. Cognitive impairment can occure unnoticed in people with HIV. Incidence of HIV infection associated cognitive impairment reach 28-38% with 37% prevalence. HIV Associated Neurocogntive Disorders (HAND) with typicaly clinical symptoms is cognitive impairment, motor function and behavior. Cognitive impairment often under diagnosed and will affect daily activities. HAND as manifestattion of AIDS increased along with HIV patients survival. Long term in Antireroviral (ARV) treatment potentially toxic and may influence the appearance of neurocognitive impairment. After 18 months ARV treatment will make improvement in HIV related neurocognitive impairment.
Purpose. To meassure cognitive function of HIV patients after dan before ARV treatment acording to age, sex, education, employment, CD4, hepatitis C, anemia and depresion.
Method. Cross sectional study involving HIV outpatients in UPT HIV RSCM (Ciptomangunkusomo Hospital) that suitable with the inclusion criteria. Basic patients data, CD4 value, hemoglobin, hamilton depresion scale were collected. Cognitive function assesment with Trial making test (TMT A and B), digit span forward and backward, animal naming, RAVLT and psikomotor pegboard.
Result. From 100 subjects, 50 after and 50 before ARV treatment. The median age in all subject is 23 year old, man and woman in equal subjects. Majority education is senior high school. Employment subjects, CD4 mean, Hepatits C reactive are higher on before ARV group. Depresion only in 3 subjects. Significanly difference found in HIV cognitive fuction with CD4, education, and ARV treatment. Slight cognitive impairment is higher on before ARV group(48%) compare with after ARV group (18%) with significally difference in backward digit span, animal naming and pegboard test.
Conclusion. Slight HIV associated cognitive impairment is higher on before ARV grup, although the patients had no complaint.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Dinda Diafiri
"Latar Belakang: Gangguan kognitif merupakan komplikasi yang umum ditemui pada pasien HIV. Hal ini disebabkan oleh kerusakan neuronal oleh infeksi HIV. Gangguan kognitif dapat mempengaruhi kualitas hidup pasien. Dengan berkembangnya terapi antiretroviral (ART) terjadi penurunan derajat keparahan gangguan kognitif dan peningkatan kualitas hidup. Penelitian ini bertujuan untuk mengetahui perubahan fungsi kognitif dan kualitas hidup hidup pasien HIV setelah ART selama 3 bulan.
Metode Penelitian: Penelitian ini merupakan studi kohort prospektif bagian dari JacCCANDO study (JAKarta CMV and Candida in HIV patients on ART evaluation in Cardiology, Neurocognitive, Dentistry and Ophtalmology Study) dimana subjek penelitian merupakan pasien HIV dengan imunodefisiensi berat (sel limfosit T CD4 < 200 sel/mL). Data yang digunakan pada penelitian adalah data sebelum dan setelah ART selama 3 bulan. Dilakukan penilaian kognitif lengkap, kualitas hidup (SF-36) serta pemeriksaan laboratorium.
Hasil: Didapatkan 51 subjek dengan rentang usia subjek ialah 19-44 tahun. Didapatkan perbaikan skor (p<0,05) pada median Z kognitif,  Z fluensi, Z eksekutif, Z keterampilan motorik, skor kesehatan fisik dan mental setelah ART 3 bulan. Tidak didapatkan korelasi antara perubahan kognitif dengan kualitas hidup baik kesehatan fisik dan mental.
Kesimpulan: Terdapat perbaikan fungsi kognitif pada domain fluensi, fungsi eksekutif dan keterampilan motorik serta perbaikan kualitas hidup baik kesehatan fisik maupun mental pada pasien HIV naïve setelah pemberian antiretroviral selama 3 bulan.

Background: Cognitive impairment is one of the common complications found in patients with HIV. It is caused by neuronal damaged of HIV infection. Cognitive impairment could influencing the patient's quality of life (QoL). However, the development of antiretroviral therapy (ART) results in a decrease of cognitive impairment severity as well as an increase of QoL. This study aims to investigate the cognitive function and QoL changes in HIV patients after 3 months of ART.
Methods: This is a prospective cohort study and a part of JacCCANDO study (JAKarta CMV and Candida in HIV patients on ART evaluation in Cardiology, Neurocognitive, Dentistry and Ophthalmology Study) where all subjects were HIV patients with severe immunodeficiency (CD4 T-lymphocyte cell < 200 cells/mL). In this study, data was taken before and after antiretroviral therapy for 3 months. Complete cognitive assessment was performed, QoL (SF-36), and laboratory examination.
Result: Fifty-one subjects were gathered in this study. The age range was within 19-44 years old. There also a score improvement (p<0.05) in Z cognitive median, Z fluency, Z executive, Z motoric skills, physical health score and mental health score after 3 months of ART. No correlation was found between cognitive changes and QoL in neither physical health nor mental health.
Conclusion: There was an improvement of cognitive function within fluency domain, executive function, and motoric skills as well as the QoL improvement in both physical and mental health amongst naïve HIV patients after 3 months of antiretroviral therapy. Overall changes of cognitive function did not affect the QoL in both physical and mental.
"
Depok: Fakultas Kedokteran Universitas Indonesia, 2018
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Herlina
"[ABSTRAK
Latar belakang: Pasien HIV anak berisiko tinggi mengalami gangguan
neurokognitif akibat keterlibatan sistem saraf pusat (SSP). Prevalens gangguan
kognitif tersebut berkisar antara 8%-62%. Pemberian ARV menurunkan viral
load di SSP sehingga mencegah penurunan fungsi kognitif. Tujuan penelitian ini
untuk memberikan gambaran fungsi kognitif pasien HIV anak dalam terapi ARV.
Metode: Studi potong lintang dilakukan terhadap pasien HIV anak berusia 5-15
tahun. Penilaian kognitif dilakukan dengan instrumen Wechsler intelligence scale
for children IV (WISC IV). Pemeriksaan elektroensefalografi bertujuan untuk
membuktikan kerusakan akibat keterlibatan SSP pada infeksi HIV.
Hasil: Sembilan puluh pasien HIV anak median usia 9 tahun telah memperoleh
ARV dengan median 69 bulan. Hasil rerata verbal, performance, dan full-scale IQ
(FSIQ) berturut-turut adalah 88,66 (SB 15,69), 85,30 (SB 15,35), dan 85,73 (SB
15,61). Enam puluh tujuh (74,4%) subjek memiliki verbal IQ normal, 56 (62,2%)
performance scale normal, dan 58 (64,4%) FSIQ normal. Hasil EEG abnormal
didapatkan pada 22 subjek (22,4%) dan tidak memiliki hubungan dengan stadium
klinis, usia dan lama pemberian ARV, serta viral load. Stadium HIV
menunjukkan hubungan bermakna dengan komponen verbal scale IQ dan FSIQ
(p=0,042 dan p=0,044). Hasil IQ tidak memiliki hubungan dengan usia pemberian
ARV, lama pemberian ARV, dan viral load.
Simpulan: Pasien HIV anak dalam terapi ARV memiliki rerata IQ abnormal pada
verbal, performance, dan FSIQ. Berdasarkan kategori hasil IQ lebih dari 50%
subjek memiliki IQ normal pada ketiga skala WISC. Studi kohort diperlukan
untuk menilai apakah pemberian ARV lebih dini dan faktor yang memengaruhi
dapat mencegah penurunan fungsi kognitif pasien HIV anakABSTRACT Introduction: Children with HIV infection are at high risk for developing
neurocognitive impairment because of central nervous system (CNS)
involvement. Prevalence of cognitive impairment is reported between 8%-62%.
Decreased viral load due to antiretroviral therapy (ARV) would prevent the
decrease of cognitive function. The aim of this study was to describe cognitive
function in HIV-infected children on ARV.
Method: We conducted cross sectional study of HIV-infected children aged 5-15
years. Wechsler intelligence scale for children IV (WISC-IV) was administered
for assessing cognitive function. Electroencephalograph was performed to prove
abnormalities caused by CNS involvement of HIV infection
Results: Ninety HIV-infected children with median age of 9 years had received
ARV for median of 69 months. The mean (SD) of verbal, performance, and full
scale IQ were 88,66 (SD 15,69), 85,30 (SD 15,35), and 85,73 (SD 15,61)
respectively. Sixty seven subjects (74,4%) had normal verbal IQ, 56 subjects
(62,2%) had normal performance IQ, and 58 subjects (64,4%) had normal FSIQ.
Twenty two children (22,4%) showed EEG abnormality which was not correlated
to clinical stage, onset and duration of ARV, and viral load. Clinical stage of HIV
showed significant association with verbal and FSIQ (p 0,042 and p 0,044). IQ
results did not have association with onset and duration of ARV and viral load.
Conclusion: HIV-infected children on ARV have abnormal mean IQ in verbal,
performance and FSIQ. Based on categorical IQ, most subjects have normal
verbal, performance, and FSIQ. Cohort study is needed to address whether early
ARV can preserve cognitive function.;Introduction: Children with HIV infection are at high risk for developing
neurocognitive impairment because of central nervous system (CNS)
involvement. Prevalence of cognitive impairment is reported between 8%-62%.
Decreased viral load due to antiretroviral therapy (ARV) would prevent the
decrease of cognitive function. The aim of this study was to describe cognitive
function in HIV-infected children on ARV.
Method: We conducted cross sectional study of HIV-infected children aged 5-15
years. Wechsler intelligence scale for children IV (WISC-IV) was administered
for assessing cognitive function. Electroencephalograph was performed to prove
abnormalities caused by CNS involvement of HIV infection
Results: Ninety HIV-infected children with median age of 9 years had received
ARV for median of 69 months. The mean (SD) of verbal, performance, and full
scale IQ were 88,66 (SD 15,69), 85,30 (SD 15,35), and 85,73 (SD 15,61)
respectively. Sixty seven subjects (74,4%) had normal verbal IQ, 56 subjects
(62,2%) had normal performance IQ, and 58 subjects (64,4%) had normal FSIQ.
Twenty two children (22,4%) showed EEG abnormality which was not correlated
to clinical stage, onset and duration of ARV, and viral load. Clinical stage of HIV
showed significant association with verbal and FSIQ (p 0,042 and p 0,044). IQ
results did not have association with onset and duration of ARV and viral load.
Conclusion: HIV-infected children on ARV have abnormal mean IQ in verbal,
performance and FSIQ. Based on categorical IQ, most subjects have normal
verbal, performance, and FSIQ. Cohort study is needed to address whether early
ARV can preserve cognitive function.;Introduction: Children with HIV infection are at high risk for developing
neurocognitive impairment because of central nervous system (CNS)
involvement. Prevalence of cognitive impairment is reported between 8%-62%.
Decreased viral load due to antiretroviral therapy (ARV) would prevent the
decrease of cognitive function. The aim of this study was to describe cognitive
function in HIV-infected children on ARV.
Method: We conducted cross sectional study of HIV-infected children aged 5-15
years. Wechsler intelligence scale for children IV (WISC-IV) was administered
for assessing cognitive function. Electroencephalograph was performed to prove
abnormalities caused by CNS involvement of HIV infection
Results: Ninety HIV-infected children with median age of 9 years had received
ARV for median of 69 months. The mean (SD) of verbal, performance, and full
scale IQ were 88,66 (SD 15,69), 85,30 (SD 15,35), and 85,73 (SD 15,61)
respectively. Sixty seven subjects (74,4%) had normal verbal IQ, 56 subjects
(62,2%) had normal performance IQ, and 58 subjects (64,4%) had normal FSIQ.
Twenty two children (22,4%) showed EEG abnormality which was not correlated
to clinical stage, onset and duration of ARV, and viral load. Clinical stage of HIV
showed significant association with verbal and FSIQ (p 0,042 and p 0,044). IQ
results did not have association with onset and duration of ARV and viral load.
Conclusion: HIV-infected children on ARV have abnormal mean IQ in verbal,
performance and FSIQ. Based on categorical IQ, most subjects have normal
verbal, performance, and FSIQ. Cohort study is needed to address whether early
ARV can preserve cognitive function., Introduction: Children with HIV infection are at high risk for developing
neurocognitive impairment because of central nervous system (CNS)
involvement. Prevalence of cognitive impairment is reported between 8%-62%.
Decreased viral load due to antiretroviral therapy (ARV) would prevent the
decrease of cognitive function. The aim of this study was to describe cognitive
function in HIV-infected children on ARV.
Method: We conducted cross sectional study of HIV-infected children aged 5-15
years. Wechsler intelligence scale for children IV (WISC-IV) was administered
for assessing cognitive function. Electroencephalograph was performed to prove
abnormalities caused by CNS involvement of HIV infection
Results: Ninety HIV-infected children with median age of 9 years had received
ARV for median of 69 months. The mean (SD) of verbal, performance, and full
scale IQ were 88,66 (SD 15,69), 85,30 (SD 15,35), and 85,73 (SD 15,61)
respectively. Sixty seven subjects (74,4%) had normal verbal IQ, 56 subjects
(62,2%) had normal performance IQ, and 58 subjects (64,4%) had normal FSIQ.
Twenty two children (22,4%) showed EEG abnormality which was not correlated
to clinical stage, onset and duration of ARV, and viral load. Clinical stage of HIV
showed significant association with verbal and FSIQ (p 0,042 and p 0,044). IQ
results did not have association with onset and duration of ARV and viral load.
Conclusion: HIV-infected children on ARV have abnormal mean IQ in verbal,
performance and FSIQ. Based on categorical IQ, most subjects have normal
verbal, performance, and FSIQ. Cohort study is needed to address whether early
ARV can preserve cognitive function.]"
Fakultas Kedokteran Universitas Indonesia, 2015
S-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Riwanti Estiasari
"Latar belakang. Infeksi HIV dapat memicu inflamasi kronik dan reaktifasi CMV yang dan dapat mempengaruhi limfosit T. Gambaran seperti ini juga ditemukan pada usia lanjut dan berhubungan dengan penyakit degeneratif termasuk gangguan kognitif. Penelitian ini bertujuan untuk mengetahui pengaruh CMV dan limfosit T terhadap fungsi kognitif pada pasien HIV usia muda.Metode. JakCCANDO JAKarta CMV and Candida in HIV patients on ART, evaluation in CArdiology, Neurocognitive, Dentistry and Ophthalmology study, merupakan studi prospektif yang dilakukan di RSUPN. dr. Cipto Mangunkusumo. Studi ini melibatkan 80 pasien HIV 19-44 tahun yang belum pernah mendapat terapi antiretroviral ARV dengan limfosit T CD4

Background. HIV can trigger chronic inflammation and CMV reactivation that affect T cell. These feature is also found in old age population and associated with degenerative disease including cognitive impairment. In this study we investigated the effects of CMV and T cells on cognitive function of younger HIV patients.Methods. JakCCANDO JAKarta CMV and Candida in HIV patients on ART, evaluation in CArdiology, Neurocognitive, Dentistry and Ophthalmology is a prospective study of patients at Cipto Mangunkusumo hospital. This study involved 80 HIV antiretroviral therapy ART naive patients 19 44 years with baseline CD4 T cell counts "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
D-Pdf
UI - Disertasi Membership  Universitas Indonesia Library
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Pratama Wicaksana
"LATAR BELAKANG: Terapi ARV telah mengubah infeksi HIV dari penyakit yang mematikan menjadi penyakit kronik yang dapat dikendalikan. Salah satu efek samping terapi ARV adalah dislipidemia yang dapat meningkatkan risiko kardiovaskular. Studi tentang dislipidemia pada anak terinfeksi HIV di negara berkembang belum banyak dilakukan. TUJUAN: Tujuan penelitian ini adalah untuk mengetahui prevalens dislipidemia pada anak terinfeksi HIV dalam terapi ARV serta faktor risiko terkait. METODE: Studi potong lintang dilakukan di poliklinik anak RSCM dari bulan Januari hingga Juli 2019. Pemeriksaan profil lipid dikerjakan pada subyek yang memenuhi kriteria inklusi dan eksklusi. Data yang dikumpulkan adalah status gizi, stadium klinis saat awal diagnosis, status imunosupresi terakhir, nilai VL terakhir, paduan ARV terakhir, dan kombinasi ARV terakhir dari rekam medis. HASIL: Dari 96 subyek yang ikut alam penelitian ini, 52 (54,2%) mengalami dislipidemia. Prevalens dislipidemia pada kelompok terapi ARV lini 2 adalah 80%, sementara pada kelompok lini 1 adalah 39%. Terdapat hubungan yang bermakna antara penggunaan paduan ARV lini 2 dengan peningkatan risiko, yaitu sebesar 6,3 kali (p<0,01 IK95% [2,4-17,1]) untuk terjadi dislipidemia dibandingkan dengan paduan lini 1.KESIMPULAN: Prevalens dislipidemia pada anak terinfeksi HIV yang mendapatkan terapi ARV cukup tinggi dengan faktor risiko yaitu penggunaan paduan ARV lini 2.

INTRODUCTION: Antiretroviral therapy has changed the status of HIV infection from a high-mortality disease into a chronic disease. One of the consequences of long-term use of ARV is dyslipidemia that may progress into cardiovascular disease in the future. OBJECTIVE: The aim of the study was to seek the prevalence of dyslipidemia among HIV-infected children receiving ARV and related risk factors. METHODS: A cross-sectional study was conducted at pediatric outpatient clinic, RSCM, from January to July 2019. Lipid profile was examined on eligible subjects and data regarding nutritional status, clinical stadium at diagnosis, latest immuno supression status, latest VL value and latest ARV combination used were obtained from medical record. RESULTS: Of 96 subjects included, 52 (54,2%) subjects experienced dyslipidemia. Prevalence of dyslipidemia among second line and first line users were 80% and 39%,respectively. The use of second-line ARV medications was associated with 6,3 times (p=0,0 CI95%[2,4-17,1]) increase of risk for dyslipidemia compared to the use of first-line therapy. CONCLUSION: Prevalence of dyslipidemia among HIV-positive children on ARV is high with second-line ARV therapy being a risk facto."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T58940
UI - Tesis Membership  Universitas Indonesia Library
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Wulunggono
"Latar Belakang. Walaupun pasien HIV mendapat terapi antiretroviral yang efektif, penurunan fungsi fisik sering ditemukan lebih awal dan menimbulkan masalah baru berupa penuaan dan frailty.
Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan prefrail dan frail pada pasien HIV dalam terapi antiretroviral.
Metode. Desain studi potong lintang pada pasien HIV usia ≥30 tahun dalam terapi ARV minimal 6 bulan. Pasien yang memenuhi inklusi dilakukan pencatatan demografis, penyakit komorbid, faktor terkait HIV seperti lama terdiagnosis, lama ARV, dan CD4, pengukuran antropometri seperti indeks massa tubuh, penilaian depresi dengan Indo BDI-II, dan penilaian frailty dengan kriteria Fried. Pasien dengan riwayat infeksi otak, kanker, dan oportunistik aktif dieksklusi. Analisis bivariat dan multivariat dilakukan pada faktor-faktor tersebut.
Hasil. Terdapat 164 pasien yang dianalisis. Proporsi prefrail sebanyak 51,2% (84 pasien) dan frail 3,7% (6 pasien), dengan komponen dominan pada kelemahan genggam. Pasien laki-laki sebanyak 72% dengan median usia (IQR) 40,5 (36-47) tahun, dan median CD4 nadir (IQR) 53 (21-147) sel/mm3, median CD4 awal (IQR) 77 (32 - 206) sel/mm3. Hepatitis C menjadi faktor komorbid terbanyak. Depresi berhubungan dengan prefrail dan frail dengan OR 2,14 (IK95%: 1,034-4,439) dan p = 0,036. Tidak terdapat hubungan faktor usia ≥50 tahun, ≥2 penyakit komorbid, lama terdiagnosis HIV ≥5 tahun, lama ARV ≥5 tahun, CD4 <200 sel/mm3, indeks massa tubuh ≥25 kg/m2, dan pendapatan rendah dengan prefrail dan frail.
Kesimpulan. Terdapat proporsi prefrail sebanyak 51,2% dan frail 3,7%. Depresi merupakan salah satu faktor yang terbukti berhubungan terhadap prefrail dan frail pada pasien HIV dalam terapi ARV.

Background. Although HIV patients receive effective antiretroviral therapy, decrease in physical function is often found earlier and creates new problems in the form of aging and frailty
Aim. to determine the proportion and factors associated with prefrail and frail in HIV patients on antiretroviral therapy.
Method. A cross-sectional study design in HIV patients aged ≥30 years who were on ARV therapy for at least 6 months. Patients who fulfilled the inclusion were recorded demographically, comorbid diseases, HIV-related factors such as length of diagnosis, duration of ARV, CD4, anthropometric measurements such as body mass index, depression assessment with Indo BDI-II, and frailty assessment with Fried criteria. Patients with a history of brain infection, cancer, and active opportunists were excluded. Bivariate and multivariate analysis was carried out on these factors.
Results. There were 164 patients analyzed. The proportions of prefrail and frail were 51.2% and 3.7% respectively, with the dominant component in muscle weakness. Male patients were 72% with median age (IQR) 40.5 (36-47) years, median baseline CD4 (IQR) 77 (32 - 206) cell/mm3, and median nadir CD4 (IQR) 53 (21-147) cells/mm3. Hepatitis C is the most comorbid factor. Depression is related to prefrail and frail with OR 2.14 (95%CI: 1,034-4,439) and p = 0,036. There was no correlation between factors such as age ≥50 years, ≥2 comorbid diseases, length of diagnosis of HIV ≥5 years, duration of ARV ≥5 years, CD4 cell count <200 cells/mm3, body mass index ≥25 kg/m2, and low income with prefrail and frail.
Conclusion. The proportions of prefrail and frail are 51.2% and 3.7% respectively. Depression is one of the factors that is proven to be related to prefrail and frail in HIV patients in ARV therapy.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Wulunggono
"Latar Belakang. Walaupun pasien HIV mendapat terapi antiretroviral yang efektif, penurunan fungsi fisik sering ditemukan lebih awal dan menimbulkan masalah baru berupa penuaan dan frailty.
Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan prefrail dan frail pada pasien HIV dalam terapi antiretroviral.
Metode. Desain studi potong lintang pada pasien HIV usia ≥30 tahun dalam terapi ARV minimal 6 bulan. Pasien yang memenuhi inklusi dilakukan pencatatan demografis, penyakit komorbid, faktor terkait HIV seperti lama terdiagnosis, lama ARV, dan CD4, pengukuran antropometri seperti indeks massa tubuh, penilaian depresi dengan Indo BDI-II, dan penilaian frailty dengan kriteria Fried. Pasien dengan riwayat infeksi otak, kanker, dan oportunistik aktif dieksklusi. Analisis bivariat dan multivariat dilakukan pada faktor-faktor tersebut.
Hasil. Terdapat 164 pasien yang dianalisis. Proporsi prefrail sebanyak 51,2% (84 pasien) dan frail 3,7% (6 pasien), dengan komponen dominan pada kelemahan genggam. Pasien laki-laki sebanyak 72% dengan median usia (IQR) 40,5 (36-47) tahun, dan median CD4 nadir (IQR) 53 (21–147) sel/mm3, median CD4 awal (IQR) 77 (32 – 206) sel/mm3. Hepatitis C menjadi faktor komorbid terbanyak. Depresi berhubungan dengan prefrail dan frail dengan OR 2,14 (IK95%: 1,034–4,439) dan p = 0,036. Tidak terdapat hubungan faktor usia ≥50 tahun, ≥2 penyakit komorbid, lama terdiagnosis HIV ≥5 tahun, lama ARV ≥5 tahun, CD4 <200 sel/mm3, indeks massa tubuh ≥25 kg/m2, dan pendapatan rendah dengan prefrail dan frail.
Kesimpulan. Terdapat proporsi prefrail sebanyak 51,2% dan frail 3,7%. Depresi merupakan salah satu faktor yang terbukti berhubungan terhadap prefrail dan frail pada pasien HIV dalam terapi ARV.

Background. Although HIV patients receive effective antiretroviral therapy, decrease in physical function is often found earlier and creates new problems in the form of aging and frailty
Aim. to determine the proportion and factors associated with prefrail and frail in HIV patients on antiretroviral therapy.
Method. A cross-sectional study design in HIV patients aged ≥30 years who were on ARV therapy for at least 6 months. Patients who fulfilled the inclusion were recorded demographically, comorbid diseases, HIV-related factors such as length of diagnosis, duration of ARV, CD4, anthropometric measurements such as body mass index, depression assessment with Indo BDI-II, and frailty assessment with Fried criteria. Patients with a history of brain infection, cancer, and active opportunists were excluded. Bivariate and multivariate analysis was carried out on these factors.
Results. There were 164 patients analyzed. The proportions of prefrail and frail were 51.2% and 3.7% respectively, with the dominant component in muscle weakness. Male patients were 72% with median age (IQR) 40.5 (36-47) years, median baseline CD4 (IQR) 77 (32 - 206) cell/mm3, and median nadir CD4 (IQR) 53 (21–147) cells/mm3. Hepatitis C is the most comorbid factor. Depression is related to prefrail and frail with OR 2.14 (95%CI: 1,034-4,439) and p = 0,036. There was no correlation between factors such as age ≥50 years, ≥2 comorbid diseases, length of diagnosis of HIV ≥5 years, duration of ARV ≥5 years, CD4 cell count <200 cells/mm3, body mass index ≥25 kg/m2, and low income with prefrail and frail.
Conclusion. The proportions of prefrail and frail are 51.2% and 3.7% respectively. Depression is one of the factors that is proven to be related to prefrail and frail in HIV patients in ARV therapy.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Kartika Maharani
"ABSTRAK
Latar Belakang: Neuropati perifer merupakan komplikasi neurologis tersering pada pasien HIV. Stavudin, yang dikaitkan dengan risiko neuropati perifer, mulai ditinggalkan sebagai pilihan pertama terapi antiretroviral. Penelitian ini bertujuan untuk mengetahui angka kejadian neuropati pada pasien HIV dalam terapi antiretroviral non stavudin menggunakan multimodalitas pemeriksaan, dan faktor risiko yang berhubungan.
Metode Penelitian: Penelitian berdesain potong lintang menggunakan data sekunder dari penelitian JakCCANDO ditambah dengan data primer dari pasien HIV dalam terapi antiretroviral non stavudin minimal 12 bulan yang berobat di Unit Pelayanan Tepadu (UPT) HIV Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM). Anamnesis dan penelusuran data faktor risiko, skrining klinis Brief Peripheral Neuropathy Screen (BPNS), elektroneurografi, dan Stimulated Skin Wrinkling (SSW) dengan krim lidokain:prilokain 5% dilakukan pada setiap subjek penelitian. Data dianalisis dengan SPSS 17.0.
Hasil: Angka kejadian polineuropati simetris distal (PSD) pada 68 subjek penelitian berdasarkan BPNS, elektroneurografi, SSW, dan kombinasi ketiga modalitas ialah 16,2%, 25%, 29,4%, dan 52,9%. Subjek dengan CD4 nadir kurang dari 50 sel/l memiliki risiko PSD sebesar 2,85 kali lebih tinggi dibandingkan kelompok subjek dengan CD4 nadir yang lebih tinggi (IK 95% 1,99-8,29). Subjek yang memiliki tinggi badan lebih dari sama dengan 170 cm (p<0,03) dan viral load lebih dari sama dengan 35.000 kopi/ml (p<0,05) memiliki rerata kecepatan hantar saraf sensorik tungkai bawah lebih rendah dibandingkan subjek dengan tinggi badan dan viral load yang lebih rendah.
Kesimpulan: Angka kejadian neuropati perifer pada pasien HIV masih cukup tinggi yaitu 52,9% dari subjek penelitian, meskipun stavudin tidak lagi digunakan. Penggunaan multimodalitas pemeriksaan memberikan kemampuan deteksi neuropati lebih banyak dibandingkan modalitas pemeriksaan tunggal. Subjek dengan CD4 nadir kurang dari 50 sel/l, 2,85 kali lebih berisiko mengalami PSD. Penelitian ini juga menunjukkan adanya hubungan antara tinggi badan lebih dari sama dengan 170 cm dan viral load lebih dari sama 35.000 kopi/ml terhadap abnormalitas parameter elektroneurografi saraf sensorik tungkai bawah.

ABSTRACT
Background: Peripheral neuropathy was a common neurologic complications in HIV patients. Stavudine, which was often associated with neuropathy risk, is no longer used as first line HAART. This study was aimed to determine prevalence of neuropathy in HIV patients receving HAART without stavudine using multi modalities examination, and associated risk factors.
Materials and Method: A cross-sectional study was undertaken using secondary data from JakCCANDO study subjects and primary data from HIV patients receiving antiretroviral therapy without stavudine for minimum 12 months in Integrated HIV Outpatient Clinics of Cipto Mangunkusumo General Hospital. All subjects were performed history taking, Brief Peripheral Neuropathy Screen (BPNS), electroneurography, and Stimulated Skin Wrinkling (SSW) using lidocaine:prilocaine 5% cream. Data analysis was done using SPSS 17.0.
Results:Prevalence of symmetric distal polyneuropathy (DSP) from 68 study subjects based on BPNS, electroneurography, SSW, and combination of three modalities were 16,2%, 25%, 29,4%, and 52,9%. Subjects with nadir CD4 less than 50 cells/l were at increased risk of DSP 2,85 times larger than subjects with higher nadir CD4 (CI 95% 1,99-8,29). Subjects with a height of equal or more than 170 cm (p<0,03) and viral load of equal or more than 35.000 copies/ml (p<0,05) had significantly decrease mean of lower extremities sensory nerve conduction velocities based on electroneurography compared to subjects with lower height and viral load.
Conclusions: Peripheral neuropathy remained a numerous neurological complication, as much as 52,9% of study subjects, even when stavudine was no longer used. Multiple diagnostic tools used in this study gave higher neuropathy number compared to single diagnostic modality. Subjects with nadir CD4 less than 50 cells/l had 2,85 times higher risk of having DSP. There were also correlation between height equal or more than 170 cm and viral load equal or more than 35.000 copies/ml with electroneurographic parameter abnormalities of sensory nerve in lower extremities.
"
Depok: Fakultas Kedokteran Universitas Indonesia, 2015
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Khalid Mohammad Shidiq
"Latar belakang. HIV/AIDS merupakan penyakit kronik yang memiliki spektrum klinis yang sangat luas, memerlukan terapi seumur hidup, dan dapat menurunkan kualitas hidup. Belum terdapat alat evaluasi keluhan penyakit dan efek samping pengobatan pasien HIV/AIDS yang sederhana untuk digunakan saat evaluasi di rawat jalan. Pemantauan keluhan secara objektif penting karena berhubungan dengan kualitas hidup dan kepatuhan berobat pasien HIV/AIDS. Belum diketahui apakah pasien HIV/AIDS yang sudah dalam terapi masih memiliki banyak keluhan yang dapat mempengaruhi kualitas hidupnya secara keseluruhan. Tujuan. Menilai keandalan kuesioner Indeks Simtom HIV untuk menilai keluhan pasien HIV/AIDS, mengetahui profil keluhan pasien HIV/AIDS di Indonesia dengan menggunakan kuesioner Indeks Simtom HIV, mengetahui korelasi keluhan dengan kualitas hidup pasien HIV/AIDS. Metode. Penelitian ini merupakan studi potong lintang pada subjek pasien HIV/AIDS yang berobat jalan rutin di poliklinik HIV. Subjek direkrut secara random pada September hingga November 2018 di RS Cipto Mangunkusumo, Jakarta. Uji coba kuesioner dilakukan pada 20, dan evaluasi keluhan dilakukan pada 87 subjek. Sebelum uji coba, dilakukan proses adaptasi bahasa kuesioner Indeks Simtom HIV yang dikembangkan Justice et al ke bahasa Indonesia dengan metode Beaton dan Guillemin. Setelah itu dilakukan uji keandalan dengan analisis Alpha Cronbach's a coefficient, serta uji validitas internal dengan multitrait scaling analysis. Selanjutnya evaluasi keluhan dilakukan pada pasien di unit pelayanan terpadu HIV RS Cipto Mangunkusumo. Bersamaan dengan itu subjek juga dinilai kualitas hidupnya dengan kuesioner WHOQOL-HIV BREF. Dilakukan analisis korelasi keluhan dengan kualitas hidup dengan analisis korelasi spearman. Hasil. Kuesioner Indeks Simtom HIV hasil adaptasi bahasa Indonesia andal (Cronbach alpha 0,760) dan valid (korelasi multitrait >0,4) untuk menilai keluhan pasien HIV/AIDS. Keluhan yang terbanyak dialami subjek adalah kelelahan (55,7%), gangguan tidur (43,3%), pusing/keliyengan (42,3%), masalah pada kulit (42,3%) dan nyeri, mati rasa, atau kesemutan di kaki atau tangan (39,2%), sementara yang paling jarang adalah demam (15,5%), batuk (20,6%), mual (20,6%), diare (21,6%), dan penurunan nafsu makan (23,7%). Korelasi keluhan pasien HIV/AIDS saat rawat jalan dengan kualitas hidup tidak ada (r=-0,245, p=0,022), terdapat korelasi sedang antara keluhan dengan tingkat independensi (r =-0,575, p < 0,001), dan terdapat korelasi lemah dengan domain fisik, sosial, lingkungan, spiritual (r > -0,3, p < 0,05). Kesimpulan. Penggunaan kuesioner Indeks Simtom HIV dalam bahasa Indonesia sahih dan andal untuk menilai keluhan pasien HIV/AIDS dengan lebih objektif. Tiga keluhan terbanyak yang dialami pasien HIV yang sudah mendapat terapi antiretroviral adalah kelelahan atau kurang energi, pusing atau keliyengan, dan gangguan tidur, keluhan tersebut berkaitan dengan efek samping terapi antiretroviral. Keluhan pasien HIV/AIDS yang sudah mendapat terapi tidak berhubungan dengan kualitas hidup.

Backgrounds. HIV/AIDS is a chronic disease with a wide clinical spectrum which needs a long life treatment, and could decrease quality of life. There is yet a simple tool to evaluate symptoms of HIV infection and treatments side effect that can be used in outpatient setting. Objective symptoms measurement is important because it is correlated to treatment adherence and progressivity of the disease. Whether symptoms in outpatient HIV subjects whom are already treated are correlated to the quality of life is not yet known. Reliability of Indonesian version of HIV Symptom Index for measuring symptoms of HIV/AIDS patients, knowing the symptom profile/pattern of HIV/AIDS patients in Indonesia using HIV Symptom Index, and knowing the correlation between symptoms and quality of life in HIV/AIDS patients. Method. It is a cross sectional study in outpatient HIV/AIDS subjects. Subjects are recruited randomly in Cipto Mangunkusumo National Hospitals HIV  clinic from September until November 2018. Questionaire reliability assessment is done on 20 subjects, and symptom evaluation is done on 87 subjects. Language adaptation from the original english version into Indonesian was done with Beaton and Guillemin method. Realibility of Indonesian version of HIV Symptom Index was tested by alpha cronbachs a coefficient analysis, and the internal validity was tested with multitrait scaling analysis. The Valid and reliable Indonesian version of HIV Symptom Index is then used to profile the symptom pattern of HIV/AIDS patients in Cipto Mangunkusumo National Hospital. Quality of life of the subjects were measured with WHOQOL-HIV BREF questionnaire. Correlation between symptoms and quality of life was analyzed with spearman correlation analysis. Result.  Indonesian version of HIV Symptom Index is reliable (cronbach alpha 0,76) and valid (multitrait correlation >0,4) to measure symptoms of HIV/AIDS patients. The most common symptom is fatigue (55,7%), followed by insomnia (43,3%), dizziness and lightheaded (42.3%), skin problems (42,3%), and pain, numbness, or tingling in the hands or feet (39,2%). The rarest symptoms are fever (15,5%), cough (20,6%), nausea or vomiting (20,6%), diarrhea (21,6%), and lost of appetite (23,7%). Symptoms of HIV/AIDS patients treated with Antiretroviral (ARV) are not correlated with the quality of life (r=0,245, p=0,022) but have a moderate correlation with independence domain (r=0,575, p<0,001), and have a weak correlation with physical, social, environment, and spiritual domains (r>-0,3, p<0,05). Conclusion. Indonesian version of HIV symptom Index is reliable and valid to measure symptoms of HIV/AIDS patiens objectively. Three most frequent symptoms are fatigue or weakness, dizzines or lightheaded, and insomnia. These symptoms are related to side effects of antiretroviral therapy. Symptoms of ARV treated HIV/AIDS patients were not correlated with the quality of life. "
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
T58728
UI - Tesis Membership  Universitas Indonesia Library
cover
Khalid Mohammad Shidiq
"Latar belakang HIV / AIDS adalah penyakit kronis dengan spektrum klinis luas yang membutuhkan perawatan seumur hidup, dan dapat menurunkan kualitas hidup. Belum ada alat sederhana untuk mengevaluasi gejala infeksi HIV dan efek samping pengobatan yang dapat digunakan dalam pengaturan rawat jalan. Pengukuran gejala objektif penting karena berkorelasi dengan kepatuhan pengobatan dan progresifitas penyakit.
Objektif. Untuk menilai keandalan Indeks Gejala HIV versi Indonesia untuk mengukur gejala pasien HIV / AIDS, dan mengetahui profil gejala / pola pasien HIV / AIDS di Indonesia menggunakan Indeks Gejala HIV.
Metode. Ini adalah studi cross sectional pada subyek HIV / AIDS rawat jalan. Subjek direkrut secara acak di klinik HIV Rumah Sakit Cipto Mangunkusumo dari September hingga November 2018. Penilaian reliabilitas onaire Questi dilakukan pada 20 subjek, dan evaluasi gejala dilakukan pada 87 subjek. Adaptasi bahasa dari versi bahasa Inggris asli ke bahasa Indonesia dilakukan dengan metode Beaton dan Guillemin. Realibility dari versi Indonesia Indeks Gejala HIV diuji dengan alpha cronbach adalah analisis koefisien, dan validitas internal itu diuji dengan multitrait analisis skala. Indeks Gejala HIV versi Indonesia yang valid dan andal kemudian digunakan untuk membuat profil pola gejala pasien HIV / AIDS di Rumah Sakit Cipto Mangunkusumo .
Hasil. Indeks Gejala HIV versi Indonesia dapat diandalkan ( cronbach alpha 0,76) dan valid ( korelasi multitrait > 0,4) untuk mengukur gejala pasien HIV / AIDS. Gejala yang paling umum adalah kelelahan (55,7%), diikuti oleh insomnia (43,3%), pusing dan pusing (42,3%), masalah kulit (42,3%), dan nyeri, mati rasa, atau kesemutan di tangan atau kaki (39,2%). Keluhan paling jarang adalah demam (15,5%), batuk (20,6%), mual atau muntah (20,6%), diare (21,6%), dan kehilangan nafsu makan (23,7%).
Kesimpulan. Indeks gejala HIV versi Indonesia dapat diandalkan dan valid untuk mengukur gejala pasien HIV / AIDS secara objektif. Gejala yang paling sering adalah kelelahan atau kelemahan, pusing atau sakit kepala ringan, susah tidur, masalah kulit, dan nyeri, mati rasa, atau kesemutan di tangan atau kaki.

Backgrounds. HIV/AIDS is a chronic disease with a wide clinical spectrum which needs a long life treatment, and could decrease quality of life. There is yet a simple tool to evaluate symptoms of HIV infection and treatment s side effect that can be used in outpatient setting. Objective symptoms measurement is important because it is correlated to treatment adherence and progressivity of the disease.
Objective. To assess reliability of Indonesian version of HIV Symptom Index for measuring symptoms of HIV/AIDS patients, and knowing the symptom profile/pattern of HIV/AIDS patients in Indonesia using HIV Symptom Index.
Method. It is a cross sectional study in outpatient HIV/AIDS subjects. Subjects are recruited randomly in Cipto Mangunkusumo Hospital s HIV clinic from September until November 2018. Questionaire reliability assessment was done on 20 subjects, and symptom evaluation is done on 87 subjects. Language adaptation from the original english version into Indonesian was done with Beaton and Guillemin method. Realibility of Indonesian version of HIV Symptom Index was tested by alpha cronbach s a coefficient analysis, and the internal validity was tested with multitrait scaling analysis. The Valid and reliable Indonesian version of HIV Symptom Index is then used to profile the symptom pattern of HIV/AIDS patients in Cipto Mangunkusumo Hospital.
Result. Indonesian version of HIV Symptom Index is reliable (cronbach alpha 0,76) and valid (multitrait correlation >0,4) to measure symptoms of HIV/AIDS patients. The most common symptom is fatigue (55,7%), followed by insomnia (43,3%), dizziness and lightheaded (42.3%), skin problems (42,3%), and pain, numbness, or tingling in the hands or feet (39,2%). The rarest symptoms are fever (15,5%), cough (20,6%), nausea or vomiting (20,6%), diarrhea (21,6%), and lost of appetite (23,7%).
Conclusion. Indonesian version of HIV symptom Index is reliable and valid to measure symptoms of HIV/AIDS patiens objectively. Most frequent symotoms are fatigue or weakness, dizzines or lightheaded, insomnia, skin problems, and pain, numbness, or tingling in the hands or feet.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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