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Ira Laurentika
Perbedaan karakteristik klinis antara pasien HIV dalam terapi antiretroviral dengan risiko kardiovaskular tinggi dan rendah. = Clinical Characteristics of HIV Infected Individu on Antiretroviral Therapy with High and Low Cardiovascular Risk
"ABSTRAK
Latar Belakang. Infeksi HIV masih merupakan masalah kesehatan mayor baik di dunia maupun Indonesia. Sejak dimulainya terapi antiretroviral (ARV), terdapat pergeseran penyebab morbiditas dan mortalitas pasien HIV. Pasien HIV berisiko lebih tinggi mengalami cardiac event melalui berbagai mekanisme. Penilaian risiko kardiovaskular dan faktor-faktor yang memengaruhinya penting untuk dilakukan terhadap semua pasien HIV.
Tujuan. Penelitian ini bertujuan untuk mengetahui prediksi risiko kardiovaskular pasien HIV dalam terapi ARV, perbedaan karakteristik klinis antara pasien risiko kardiovaskular tinggi dan rendah, serta hubungan lama penggunaan ARV, kepatuhan minum obat, hitung limfosit T CD4 nadir, serta perubahan indeks massa tubuh (IMT) terhadap risiko kardiovaskular.
Metode. Penelitian ini merupakan studi potong lintang yang melibatkan pasien HIV dalam terapi ARV minimal 6 bulan. Setiap pasien yang masuk penelitian dicatat data demografis, riwayat penyakit, pengobatan, dan kebiasaan serta dilakukan pengukuran antropometri. Pasien kemudian diminta datang kembali untuk pemeriksaan profil lipid. Risiko kardiovaskular dihitung dengan D:A:D risk scores dan dituangkan dalam bentuk persentase. Uji hipotesis yang dilakukan adalah uji T atau Mann-Whitney untuk data numerik, dan Chi-square untuk data kategorik.
Hasil. Terdapat 186 subjek penelitian yang dimasukkan ke dalam analisis. Proporsi subjek penelitian dengan risiko kadiovaskular tinggi adalah 14,52%. Seluruh subjek yang termasuk ke dalam kelompok risiko tinggi adalah laki-laki dengan usia yang relatif muda. Dislipidemia dan obesitas sentral lazim terjadi pada kelompok risiko tinggi. Terdapat perbedaan bermakna antara hitung limfosit T CD4 nadir dan riwayat putus obat antara subjek risiko tinggi dan rendah (OR:7,072,IK 95%: 0,92-54,006, p:0,032 dan OR: 3,364, IK 95%: 1,458-7,784, p: 0,003. Selain itu, terdapat perbedaan bermakna median lama penggunaan ARV dan rerata delta IMT antara kelompok risiko tinggi dan rendah (p:0,002 dan p: 0,018).
Kesimpulan. Proporsi pasien HIV dengan risiko kardiovaskular tinggi pada penelitian ini sebesar 14,5%. Terdapat beberapa perbedaan bermakna dalam hal hitung limfosit T CD4 nadir, riwayat putus ARV, lama penggunaan ARV dan delta IMT antara subjek dengan risiko kardiovaskular tinggi dan rendah
ABSTRACT
Background. Human immunodeficienncy virus (HIV) infection remains a major health problem worldwide. Ever since the discovery ov antiretroviral (ARV), there are shift in causes of morbidity and mortality among HIV patients. Patients with HIV are at greater risk to cardiac event due to different mechanisms. Cardiovascular risk assessment and the associated factors are indispensible to do for all HIV patients.
Objective. This study aims to predict cardiovascular risk among HIV patients on ARV therapy, to investigate clinical characteristic differences between high risk and low risk group, and to examine the relationship of , nadir limfosit T CD4count, compliance, duration of ARV, and body mass index (BMI) changes toward cardiovascular risk.
Method. This study was a cross sectional study involving HIV patient on ARV therapy for at least 6 months. Demographic data, history of illness, therapy, and habit were taken from each patients. Antropometry measurement was also conducted and blood drawing for lipid profile test was performed in the next appointment. Cardiovascular risk was assessed using D:A:D risk score and the proportion was presented in percentage. Hipothesis tests were performed using T test or Mann-Whitney test for numerical data and x2 test for categorical data.
Results. There were 186 subjects included in the analysis. Proportion of subjects with high cardiovascular risk was 14.52%. All subjects with high cardiovascular risk was male with relatively young age. Dyslipidemia and central obesity were very common among patints in high risk group. There were significant difference in proportion of patients with nadir limfosit T CD4 count <200 cell/mm3 and history of bad compliance between high and low risk group (OR:7,072, 95% CI: 0,92-54,006, p:0,032; OR: 3,364,95% CI: 1,458-7,784, p: 0,003, respectively). Furthermore, there was also significant differences between median duration of ARV use and mean of IMT changes between two groups (p:0,002 dan p: 0,018).
Conclusion. Proportion of HIV patients with high cardiovascular risk in this study was 14.5%. There were significant differences regarding nadir limfosit T CD4 count, history of compliance, duration of ARV use, and IMT changes between subjects with high and low cardiovascular risk."
2019
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UI - Tugas Akhir  Universitas Indonesia Library
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Rizki Febriani Putri
Proporsi jatuh, proporsi risiko jatuh dan faktor-faktor yang berhubungan pada pasien HIV/AIDS dalam terapi antiretroviral = Proportions of fall, proportion of fall risk, and associated factors in HIV/AIDS patients on antiretroviral therapy
"Latar Belakang Walaupun mendapatkan terapi antiretroviral (ARV), inflamasi kronik akibat infeksi HIV dikombinasikan dengan faktor-faktor lain menyebabkan proses penuaan lebih dini pada pasien HIV/AIDS, salah satu tandanya risiko jatuh.
Tujuan Mengetahui proporsi kejadian jatuh dan risiko jatuh serta faktor faktor yang berhubungan pada pasien HIV/AIDS dalam terapi ARV.
Metode Studi potong lintang dilakukan pada pasien HIV/AIDS berusia > 40 tahun dalam terapi ARV minimal 6 bulan. Pada pasien yang memenuhi kriteria inklusi dilakukan pencatatan data demografis, pengukuran antropometri, faktor terkait HIV, terapi ARV, komorbid, obat, penilaian depresi dengan Indo-BDI-II, neuropati dengan kriteria Toronto, frailty dengan kriteria Fried, dan risiko jatuh dengan uji Timed Up and Go (TUG). Pasien menolak, tidak dapat berjalan dan memiliki gangguan motorik dieksklusi. Analisis bivariat dan multivariat dilakukan pada faktor-faktor tersebut.
Hasil Dari 102 sampel didapatkan proporsi kejadian jatuh 24,5% dan risiko jatuh sebesar 51,96%. Subjek mayoritas laki-laki (83,3%), median usia (IQR) 45 (5) tahun, CD4 nadir median (IQR) 71,5 (220,25) sel/mm3, CD4 saat ini median (IQR) 495,5 (361) sel/mm3, komorbid terbanyak hepatitis C (31,3%), polifarmasi 21,6% subjek, dalam terapi lini 2 ARV (10.78%), depresi (14,71%), neuropati 38,2%) prefrail 53,9% dan frail 14,7%, penapisan demensia 14,7%. Faktor yang berhubungan dengan risiko jatuh adalah prefrail/frail (OR 6,395, IK95% 2,348-17,417 p<0,001) riwayat jatuh (OR 3,162 IK95% 1,085-9,212 p 0,035) dan penggunaan Efavirenz (OR 5,878 IK95% 1,083-31,906 p 0,040).
Kesimpulan Proporsi kejadian jatuh pada pasien HIV/AIDS dalam terapi ARV meyerupai populasi geriatri non HIV dengan risiko jatuh 52%. Faktor yang behubungan adalah status prefrail/frail, riwayat jatuh sebelumnya, dan penggunaan Efavire
Background Despite given Antiretroviral Therapy (ART), chronic inflammation due to HIV infection combined with other factors implicate in the early aging process. Fall risk is one of the aging symptoms that can be assessed objectively.
Aims To determine proportion of any fall and factors associated with risk of fall in PLWH undergoing antiretroviral therapy.
Methods cross sectional study in PLWH aged 40 years or older who has take ART at least for 6 months. Data were recorded in subjects fulfilled inclusion criteria, including demographic data, anthropometry measurements, HIV related factors, comorbidities, drugs prescribed, depression using Indo-BDI-II questionnaire, neuropathy assesment sing Toronto Scoring criteria, Fried criteria frailty, and fall risk assessed by Timed Up and Go Test. Patients denied to participate, unable to walk, or having motoric abnormality in upper extremity was excluded. Bivariat and multivariat analysis was carried out to these factors.
Results among 102 subjects, proportions of any falls was 24,5% subjects and proportions of fall risk was 52%. Most of subjects were male (83,3%), median of age (IQR) was 45 (5) years, with nadir CD4 (IQR) was 71,5 (220,25) cell/mm3 and current CD4 was 495,5 (361) cells/mm3. Hepatitis C was the most comorbid disease (31,3%), polypharmacy prescribed in 21,6%, and 10,8% were in LPV/r therapy. Factors included were depression found in 14,7%, neuropathy in 38,2%m prefrail 53,9%, frail 14,7%, and patients positive screened for dementia 14,7%. Significant factors associated with risk of fall were prefrail/frail status (OR 6,395, IK95% 2,348-17,417 p<0,001), history of fall (OR 3,162 IK95% 1,085-9,212 p 0,035), and under EFV prescription (OR 5,878 IK95% 1,083-31,906 p 0,040).
Conclusion proportion of any fall in PLWH undergoing antiretroviral therapy resembled those in geriatric population, with high rate of fall risk up to 52% of the patients. Factors associated with risk of fall were frail/prefrail status, history of previous fall, and current EFV use."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Wulunggono
Proporsi dan Faktor-Faktor yang Berhubungan dengan Frailty pada Pasien HIV dalam Terapi Antiretroviral = Proportions and Factors Associated with Frailty in HIV Patients on Antiretroviral Therapy
"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
Proporsi dan Faktor-Faktor yang Berhubungan dengan Frailty pada Pasien HIV dalam Terapi Antiretroviral = Proportions and Factors Associated with Frailty in HIV Patients on Antiretroviral Therapy
"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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Yosephine Yossy
Faktor faktor yang beruhubungan dengan kadar testosteron bebas pada pria dengan HIV dalam terapi Antiretroviral = Factors associated with free testosterone level of HIV infected male on antiretroviral therapy
"[ABSTRAK
Latar Belakang. Penderita HIV/AIDS di Indonesia semakin meningkat, sedangkan infeksi HIV/AIDS maupun terapi ARV dapat menyebabkan penurunan kadar testosteron yang sangat memengaruhi kualitas hidup penyandang HIV/AIDS. Gejala dan tanda penurunan kadar testosteron pada pria dengan HIV sangat tidak spesifik, sedangkan pemeriksaan laboratorium sangat mahal, sehingga perlu diketahui faktor-faktor pada pasien yang dapat memprediksi penurunan kadar testosteron.
Tujuan. Mengetahui apakah jumlah CD4 awal, lamanya terapi ARV, jenis ARV, lipodistrofi dan besarnya lingkar pinggang memengaruhi kadar testosteron bebas pada pria dengan HIV yang mendapat ARV.
Metode. Penelitian potong lintang dilakukan pada bulan Maret 2015 di Unit Pelayanan HIV Terpadu RSCM, Jakarta. Subjek adalah pria dengan HIV berusia 18-40 tahun, mendapat ARV teratur sekurangnya dalam 1 tahun terakhir. Pemeriksaan meliputi anamnesis, pengukuran lingkar pinggang dan lipodistrofi, pemeriksaan kadar testosteron total, SHBG dan testosteron bebas (Free Testosteron Index: FTi). Uji regresi linier digunakan untuk menilai faktor-faktor yang berhubungan dengan kadar testosteron bebas pada penelitian ini.
Hasil. Dari 54 subjek, didapatkan median usia 35,11 tahun (21-40), median lamanya ARV 59 bulan (16-129), median CD4 awal 57/mm3 (3-443), rerata lingkar pinggang 82,4cm (SB 10,33). Subjek yang mengalami lipodistrofi sebanyak 17 orang (32%). Subjek yang menggunakan ARV lini pertama 48 orang. Median kadar testosteron bebas 30,87% (9,78-85,64) dan subjek yang memiliki kadar testosteron bebas rendah sebanyak 32 orang(59%). Terdapatnya lipodistrofi (p=0,003, OR= -12,25) dan lamanya menggunakan ARV (p=0,002, OR=-0,182) berhubungan dengan kadar testosteron bebas pada penelitian ini.
Simpulan : Pada pria dengan HIV yang mendapat terapi ARV, adanya lipodistrofi dan lamanya terapi ARV berhubungan dengan kadar testosteron bebas. Kadar CD4 awal, jenis ARV dan lingkar pinggang tidak berhubungan dengan kadar testosteron bebas.
ABSTRACT
Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.
Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.
Method. A cross-sectional study was conducted March 2015 in HIV Integrated Clinic, RSCM, Jakarta. The subjects were 18-40 years old, got regular ARV therapy for at least 1 year. Examination includes measuring waist circumference, presence of lipodystrophy, examination of total testosterone, SHBG and free testosterone level (Free Testosterone Index:FTi). Linear regression used to analyze factors associated with free testosterone level in this study.
Results. Of 54 subjects examined, the median age was 35.11 years (21-40), median duration of antiretroviral therapy was 59 months (16-129), mean of waist circumference was 82.4 cm (SB 10.33), median of initial CD4 level was 57/mm3 (3-443). Total subjects with lipodystrophy were 17 subjects (32%), subjects who used first-line combination were 48 and 6 subjects used a second line combination. Median level of free testosterone levels was 30.87% (9.78-85.64) and there were 32 subjects with a low free testosterone level (59%). The presence of lipodystrophy (p=0,003, OR=-12,225) and duration of antiretroviral therapy (p=0,002, OR=-0,182) are associated with free testosterone level.
Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels.;Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.
Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.
Method. A cross-sectional study was conducted March 2015 in HIV Integrated Clinic, RSCM, Jakarta. The subjects were 18-40 years old, got regular ARV therapy for at least 1 year. Examination includes measuring waist circumference, presence of lipodystrophy, examination of total testosterone, SHBG and free testosterone level (Free Testosterone Index:FTi). Linear regression used to analyze factors associated with free testosterone level in this study.
Results. Of 54 subjects examined, the median age was 35.11 years (21-40), median duration of antiretroviral therapy was 59 months (16-129), mean of waist circumference was 82.4 cm (SB 10.33), median of initial CD4 level was 57/mm3 (3-443). Total subjects with lipodystrophy were 17 subjects (32%), subjects who used first-line combination were 48 and 6 subjects used a second line combination. Median level of free testosterone levels was 30.87% (9.78-85.64) and there were 32 subjects with a low free testosterone level (59%). The presence of lipodystrophy (p=0,003, OR=-12,225) and duration of antiretroviral therapy (p=0,002, OR=-0,182) are associated with free testosterone level.
Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels.;Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.
Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.
Method. A cross-sectional study was conducted March 2015 in HIV Integrated Clinic, RSCM, Jakarta. The subjects were 18-40 years old, got regular ARV therapy for at least 1 year. Examination includes measuring waist circumference, presence of lipodystrophy, examination of total testosterone, SHBG and free testosterone level (Free Testosterone Index:FTi). Linear regression used to analyze factors associated with free testosterone level in this study.
Results. Of 54 subjects examined, the median age was 35.11 years (21-40), median duration of antiretroviral therapy was 59 months (16-129), mean of waist circumference was 82.4 cm (SB 10.33), median of initial CD4 level was 57/mm3 (3-443). Total subjects with lipodystrophy were 17 subjects (32%), subjects who used first-line combination were 48 and 6 subjects used a second line combination. Median level of free testosterone levels was 30.87% (9.78-85.64) and there were 32 subjects with a low free testosterone level (59%). The presence of lipodystrophy (p=0,003, OR=-12,225) and duration of antiretroviral therapy (p=0,002, OR=-0,182) are associated with free testosterone level.
Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels.;Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.
Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.
Method. A cross-sectional study was conducted March 2015 in HIV Integrated Clinic, RSCM, Jakarta. The subjects were 18-40 years old, got regular ARV therapy for at least 1 year. Examination includes measuring waist circumference, presence of lipodystrophy, examination of total testosterone, SHBG and free testosterone level (Free Testosterone Index:FTi). Linear regression used to analyze factors associated with free testosterone level in this study.
Results. Of 54 subjects examined, the median age was 35.11 years (21-40), median duration of antiretroviral therapy was 59 months (16-129), mean of waist circumference was 82.4 cm (SB 10.33), median of initial CD4 level was 57/mm3 (3-443). Total subjects with lipodystrophy were 17 subjects (32%), subjects who used first-line combination were 48 and 6 subjects used a second line combination. Median level of free testosterone levels was 30.87% (9.78-85.64) and there were 32 subjects with a low free testosterone level (59%). The presence of lipodystrophy (p=0,003, OR=-12,225) and duration of antiretroviral therapy (p=0,002, OR=-0,182) are associated with free testosterone level.
Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels.;Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.
Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.
Method. A cross-sectional study was conducted March 2015 in HIV Integrated Clinic, RSCM, Jakarta. The subjects were 18-40 years old, got regular ARV therapy for at least 1 year. Examination includes measuring waist circumference, presence of lipodystrophy, examination of total testosterone, SHBG and free testosterone level (Free Testosterone Index:FTi). Linear regression used to analyze factors associated with free testosterone level in this study.
Results. Of 54 subjects examined, the median age was 35.11 years (21-40), median duration of antiretroviral therapy was 59 months (16-129), mean of waist circumference was 82.4 cm (SB 10.33), median of initial CD4 level was 57/mm3 (3-443). Total subjects with lipodystrophy were 17 subjects (32%), subjects who used first-line combination were 48 and 6 subjects used a second line combination. Median level of free testosterone levels was 30.87% (9.78-85.64) and there were 32 subjects with a low free testosterone level (59%). The presence of lipodystrophy (p=0,003, OR=-12,225) and duration of antiretroviral therapy (p=0,002, OR=-0,182) are associated with free testosterone level.
Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels., Background. There are increasing numbers of people living with HIV/AIDS in Indonesia. HIV/AIDS infection could cause a decrease in testosterone level which affect patients? quality of life. Symptoms of decreasing testosterone level in HIV infected male are very unspecific, while laboratory tests are costly. Therefore it is important to know factors that could predict a decrease in HIV patient?s testosterone level.
Purpose. To know the correlation between initial CD4 count, duration and type of ARV, lipodystrophy, size of waist circumference with free testosterone level of HIV infected male on ARV.
Method. A cross-sectional study was conducted March 2015 in HIV Integrated Clinic, RSCM, Jakarta. The subjects were 18-40 years old, got regular ARV therapy for at least 1 year. Examination includes measuring waist circumference, presence of lipodystrophy, examination of total testosterone, SHBG and free testosterone level (Free Testosterone Index:FTi). Linear regression used to analyze factors associated with free testosterone level in this study.
Results. Of 54 subjects examined, the median age was 35.11 years (21-40), median duration of antiretroviral therapy was 59 months (16-129), mean of waist circumference was 82.4 cm (SB 10.33), median of initial CD4 level was 57/mm3 (3-443). Total subjects with lipodystrophy were 17 subjects (32%), subjects who used first-line combination were 48 and 6 subjects used a second line combination. Median level of free testosterone levels was 30.87% (9.78-85.64) and there were 32 subjects with a low free testosterone level (59%). The presence of lipodystrophy (p=0,003, OR=-12,225) and duration of antiretroviral therapy (p=0,002, OR=-0,182) are associated with free testosterone level.
Conclusions. Among HIV infected male who receiving antiretroviral therapy, the presence of lipodystrophy and duration of antiretroviral therapy are associated with free testosterone levels. There were no association between initial CD4 count, type of antiretroviral therapy and waist circumference with free testosterone levels.]"
2015
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Herlina
Gambaran kognitif pasien HIV anak yang telah memperoleh terapi Antitretrovirus = Cognitive profile in HIV infected children on Antiretroviral therapy
"[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
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Anyeliria Sutanto
Gambaran kualitas hidup pasien HIV dengan neuropati perifer dalam terapi antiretroviral non-stavudin = Quality of life of HIV patients with peripheral neuropathy receiving non stavudine antiretroviral therapy
"Latar Belakang: Neuropati perifer merupakan salah satu komplikasi neurologis yang banyak ditemui pada pasien HIV. Hal ini dapat disebabkan oleh infeksi HIV tersebut ataupun sebagai akibat efek samping terapi antiretroviral, khususnya stavudin. Manifestasi klinis neuropati sangat beragam, salah satunya ialah adanya keluhan nyeri, yang dapat mempengaruhi kualitas hidup pasien. Penelitian ini bertujuan untuk mengetahui pengaruh neuropati perifer terhadap kualitas hidup pasien HIV dalam terapi antiretroviral non-stavudin.
Metode Penelitian: Penelitian ini merupakan studi komparatif potong lintang yang melibatkan pasien HIV di RS Cipto Mangunkusumo pada bulan September 2016 hingga September 2017. Kriteria inklusi subjek ialah pasien HIV dewasa dalam terapi antiretroviral non-stavudin selama minimal 12 bulan yang akan dibagi menjadi dua kelompok, berdasarkan brief peripheral neuropathy screening tool BPNST , yaitu kelompok dengan neuropati perifer dan tanpa neuropati perifer. Penilaian depresi dengan Hamilton depression rating scale HDRS dan evaluasi kualitas hidup dengan short form-36 health survey SF-36 . Kuesioner SF-36 mencakup domain kesehatan fisik dan kesehatan mental dengan rentang skor 0-100. Skor yang lebih tinggi menunjukkan kualitas hidup yang lebih baik. Data dianalisis dengan SPSS 20.0.
Hasil: Didapatkan subjek sebanyak 29 orang pada kelompok neuropati perifer dan 58 orang pada kelompok tanpa neuropati perifer. Rentang usia subjek ialah 23-59 tahun dengan median kadar sel limfosit T CD4 yang lebih rendah 406 sel/mm3 vs. 540 sel/mm3 dan persentase riwayat terapi isoniazid yang lebih tinggi 62,1 vs. 37,9 pada kelompok neuropati perifer. Karakteristik demografis usia, jenis kelamin, pendidikan terakhir, pekerjaan, status pernikahan dan karakteristik klinis jumlah sel limfosit CD4 terakhir tidak mempengaruhi kualitas hidup pada kedua kelompok, baik dengan maupun tanpa neuropati perifer. Tidak didapatkan perbedaan skor SF-36 yang bermakna pada kedua kelompok. Tampak median skor SF-36 yang lebih rendah pada subjek dengan nyeri neuropatik pada ekstremitas bawah skor kesehatan fisik 77,5 vs. 85,31 dan depresi skor kesehatan fisik 80 vs. 94,37 dan skor kesehatan mental 75 vs 89,68 untuk kelompok neuropati, skor kesehatan fisik 78,75 vs. 90,31 dan skor kesehatan mental 70,72 vs 88,75 untuk kelompok tanpa neuropati . Viral load RNA HIV berkorelasi negatif terhadap skor SF-36 pada kelompok dengan neuropati perifer skor kesehatan fisik, rs = -0,376 dan skor kesehatan mental, rs = -0,308.
Kesimpulan: Neuropati perifer tidak mempengaruhi kualitas hidup pasien HIV dalam terapi antiretroviral non-stavudin.Kata Kunci: antiretroviral non-stavudin, HIV, kualitas hidup, neuropati perifer.
Background Peripheral neuropathy is one of the most common neurologic complications in patients with HIV, which is caused by the HIV infection itself or as the side effect of antiretroviral therapy ART , particularly the usage of stavudine. Patients with neuropathy might complain various clinical manifestations, including pain, which could significantly affect patients quality of life. Aim of this study was to evaluate the role of peripheral neuropathy to quality of life of patients with HIV receiving non stavudine antiretroviral therapy.
Materials and Method This was a cross sectional internal comparison study which were done to HIV patients in Cipto Mangunkusumo Hospital during September 2016 to September 2017. Inclusion criteria were HIV adult patients with non stavudine antiretroviral therapy for minimum of 12 months which will be divided into two groups, based on brief peripheral neuropathy screening tool BPNST , as neuropathy group and non neuropathy group. Diagnosis of depression by Hamilton depression rating scale HDRS , and evaluation of quality of life was based on 36 item short form survey SF 36 . The SF 36 assessed physical health PH and mental health MH domain with score ranged from 0 to 100, in which higher score represents better quality of life. Data was analyzed using SPSS 20.0.
Results There were 29 subjects with peripheral neuropathy and 58 subjects without peripheral neuropathy. Age of the subjects was ranging from 23 to 59 years old, with lower median of CD4 lymphocyte count 406 cells mm3 vs. 540 cells mm3 and higher percentages of isoniazid therapy 62.1 vs. 37.9 in neuropathy group. Demographic characteristics age, sex, education level, employment, marital status and clinical characteristic CD4 lymphocyte count was not affecting the quality of life, both in neuropathy group and non neuropathy group. No significant difference was found from SF 36 score in both groups. There were lower SF 36 score median in subjects with neuropathic pain in lower extremities PH score 77.5 vs. 85.31 and depression PH score 80 vs. 94.37 and MH score 75 vs 89.68 in neuropathy group, PH score 78.75 vs. 90.31 and MH score 70.72 vs 88.75 in non neuropathy group. Viral load was negatively correlated with SF 36 score in subjects with peripheral neuropathy PH score, rs 0,376 and MH score, rs 0,308.
Conclusion Peripheral neuropathy did not affect the quality of life of HIV patients receiving non stavudin antiretroviral therapy."
Depok: Universitas Indonesia, 2017
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Kartika Maharani
Gambaran neuropati pada pasien HIV dalam terapi antiretroviral non stavudin dan faktor-faktor yang berhubungan = Peripheral neuropathy in HIV patients receiving highly active antiretroviral therapy without stavudine and associated risk factors / 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
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Sari Nurul Hanifa
Proporsi Kualitas Tidur Buruk Pasien dengan HIV dalam Terapi Antiretroviral = Proportion of Poor Quality of Sleep in Patientts with HIV on Antiretroviral
"

Latar Belakang. Kualitas tidur buruk merupakan salah satu komorbiditas yang sering terjadi pada pasien dengan HIV. Secara khusus, populasi pasien dengan HIV lebih rentan untuk memiliki kualitas tidur yang buruk yang diakibatkan oleh berbagai faktor yaitu efek samping terapi antiretroviral, psikososial,dan gangguan imunitas. Penelitian ini bertujuan untuk mengetahui proporsi kualitas tidur buruk pada pasien dengan HIV dalam terapi antiretroviral (ARV) dan faktor-faktor yang berhubungan.

Metode. Penelitian potong lintang ini dilakukan di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta pada September 2016 sampai Februari 2017. Kriteria inklusi adalah pasien dengan HIV dewasa yang mengkonsumsi terapi antiretroviral selama minimal 12 bulan. Kualitas tidur ditentukan dengan kuesioner Pittsburgh sleep quality index (PSQI) yang terdiri dari 9 pertanyaan, dengan skor >5 menunjukkan kualitas tidur buruk. Risiko tinggi obstructive sleep apnea (OSA), excessive daytime sleepiness (EDS), dan depresi diperiksa dengan kuesioner Berlin, Epworth sleepiness scale (ESS) and Hamilton depression rating scale (HDRS).

Hasil. Sembilan puluh empat subjek dalam penelitian, berusia antara 20 hingga 59 tahun, sebagian besar subjek 72,3 % adalah laki-laki, 80,9% subjek memiliki viral load terakhir tidak terdeteksi dan 84,9% subjek hitung sel limfosit CD4+ terakhir >200 sel/m3. Didapatkan proporsi kualitas tidur buruk 53,2% subjek, risiko tinggi OSA 8,5% dan EDS 9,6%. Pada analisis univariat, risiko tinggi OSA dan depresi merupakan faktor yang berhubungan dengan kualitas tidur buruk. Depresi merupakan faktor yang berhubungan dengan kualitas tidur buruk pada analisis mulitavirat (OR 4.4; IK 95% 1.7-11.4). Sedangkan, faktor lain seperti demografi, status imunologi dan virologi tidak berhubungan secara signifikan dengan kualitas tidur.

Kesimpulan. Kualitas tidur buruk sering terjadi pada pasien dengan HIV dalam terapi antiretroviral. OSA dan depresi merupakan faktor yang harus diwaspadai pada pasien HIV dengan kualitas tidur buruk. Oleh karena itu, skrining kualitas tidur, depresi dan OSAharus dilakukan secara rutin pada pasien dengan HIV.

Background: Poor quality of sleep is one of the common comorbidities in HIV patients. Patients with HIV are particularly vulnerable to poor sleep quality due to multiple factors, including antiretroviral side effects, psychosocial, and immune dysfunction. The aim of this study is to determine the proportion of poor quality of sleep in HIV patients on antiretroviral therapy (ART) and associated factors.

Materials and Method: This was a cross sectional study in Cipto Mangunkusumo Hospital during September 2016 to February 2017. Inclusion criteria were HIV adult patients on ART for minimum of 12 months. Quality of sleep was determine based on 9 items self-administered questionnaire Pittsburgh sleep quality index (PSQI), with score >5 represents poor sleep quality. High risk of obstructive sleep apnea (OSA), excessive daytime sleepiness (EDS) and depression were assessed by Berlin questionnaire, Epworth sleepiness scale (ESS) and Hamilton depression rating scale (HDRS), respectively.

Results: Among 94 subjects, age ranging from 20-59 years old, 72.3% were male, 80.9% had current viral load undetected and 84.9% had current CD4+ lymphocyte >200 cells/m3. Proportion of poor sleep quality, high risk of OSA and EDS were 53.2%, 8.5% and 9.6%, respectively. High risk of OSA and depression were associated with poor sleep quality on univariate analysis. However, depression was the only factor that associated with poor sleep quality (OR 4.4; 95% CI 1.7-11.4) on multivariate analysis. Other factors such as demographic, immunology and virology status were not significantly associated with sleep quality.

Conclusion: Poor sleep quality is common among HIV patients on ART. Obstructive Sleep Apnea and depression were factors that should be aware of in HIV patient with poor sleep quality. Therefore, screening of sleep quality, depression and OSA should be performed routinely on HIV patients.

"
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
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Adelia Nova Prahasary
Korelasi leptin, adiponektin dan rasio leptin-adiponektin dengan resistensi insulin pada pasien HIV dalam terapi antiretroviral berbasis inhibitor protease = Correlation of leptin, adiponectin and leptin-adiponectin ratio with insulin resistance in HIV patient on protease inhibitor based antiretroviral therapy
"Latar Belakang.
Pengobatan antiretroviral (ARV) di Indonesia, meliputi dua lini. Lini kedua terdiri dari kombinasi dua NRTI (Nucleoside Reverse Trancriptase Inhibitor) dan satu PI (protease inhibitor). Protease inhibitor adalah salah satu ARV yang diketahui dapat menyebabkan lipodistrofi, yang seringkali berkembang mengalami resistensi insulin, dan berhubungan dengan peningkatan risiko kardiovaskular. Peningkatan FFA (free fatty acids) dan TNF-α akibat lipolisis sel lemak pada lipodistrofi, beberapa sitokin yang dilepaskan oleh jaringan lemak (adipokin), seperti leptin dan adiponektin dipikirkan memiliki peran terhadap resistensi insulin. Leptin dan adiponektin memiliki kaitan erat dengan metabolisme glukosa dan sensitivitas insulin.
Tujuan.
Mengetahui korelasi leptin, adiponektin dan rasio leptin-adiponektin dengan HOMA-IR pada pasien HIV/AIDS dalam terapi anti retroviral berbasis inhibitor protease.
Metode.
Studi potong lintang dengan populasi terjangkau adalah pasien HIV/AIDS dewasa yang mendapatkan terapi ARV lini ke dua di RSUPN Cipto Mangunkusumo pada September– Desember 2018. Analisis data digunakan untuk mendapat koefisien korelasi leptin, adiponektin dan rasio leptin-adiponektin dengan HOMA-IR
Hasil.
Sebanyak 111 subjek penelitian dengan subjek laki – laki sebanyak 91 orang (81%). Median usia subjek penelitian 39 tahun. Median lingkar perut 83,1 cm dan IMT 22,91 ± 3,91 kg/m2. Sebanyak 60,4% dari subjek penelitian mengalami hipertrigliseridemia, dan 85% memiliki kadar HDL yang rendah. Pada penelitian didapatkan median HOMA IR 2,91, median adiponektin 11,4 μg/mL, median leptin 9,9 ng/mL, dan median rasio leptin adiponektin 0,74. Pada penelitian ini didapatkan koefisien korelasi antara leptin dengan HOMA-IR 0.434 dengan p <0,001, adiponektin dengan HOMA IR -0,214 dengan p <0,05 dan rasio leptin-adiponektin dengan HOMA-IR, didapatkan nilai r 0,417 dengan p <0,001.
Kesimpulan.
Terdapat korelasi positif bermakna antara leptin dan rasio leptin-adiponektin dengan HOMA- IR, sedangkan untuk adiponektin dengan HOMA-IR didapatkan korelasi negatif bermakna.
Background.
Antiretroviral (ARV) treatment in Indonesia includes two lines. The second line consists of a combination of two NRTIs (Nucleoside Reverse Trancriptase Inhibitors) and one PI (protease inhibitor). Protease inhibitors are ARV drugs known to cause lipodystrophy. Patients who are on HAART (highly active antiretroviral therapy), and have lipodystrophy, often develop insulin resistance which is associated with increased risk for cardiovascular disease. Increasing of FFA (free fatty acids) and TNF-α (tumor necrosis factor-alpha) in result of lipodystrophy, also several cytokines (adipokines) released by adipose tissue, such as leptin and adiponectin, also known as adipocytokines or adipokines, may play a role to insulin reistance. Leptin and adiponectin are linked to glucose metabolism and insulin sensitivity.
Objective.
Knowing the correlation of leptin, adiponectin and leptin-adiponectin ratio with HOMA-IR in HIV/AIDS patient on protease inhibitor based anti retroviral therapy.
Methods.
Cross sectional study with an affordable population of HIV/ AIDS patient on protease inhibitor- based ARV therapy in Cipto Mangunkusumo Hospital from September – December 2018. Data Analysis was used to obtain the coefficient of correlation of leptin, adiponectin and leptin- adiponectin ratio with HOMA-IR.
Results.
There were 111 subjects with 91% males. Median’s age of study subject 39 years. Median of abdominal circumference 83,1 cm and median of body mass index 22,91 ± 3,91 kg/m2. Hypertriglyceridemia was found in 60,4% from subjects and 85% had low HDL level. Median of HOMA IR 2,91, Median of adiponectin 11,4 μg/mL, median of leptin 9,9 ng/mL, median of leptin adiponectin ratio 0,74. Coefficient of correlation between leptin and HOMA-IR was 0,434 with p value <0,001, adiponectin and HOMA-IR -0,214 with p value <0.05 and leptin- adiponectin ratio 0,417 with p value <0,001
Conclusion.
A significant positive correlation between leptin and leptin-adiponectin ratio with HOMA-IR was obtain, also a significant negative correlation was obtained between adiponectin and HOMA-IR."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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