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Ardiana Kusumaningrum

Mutasi genetik dan resistensi obat HIV (HIVDR) golongan NRTI, NNRTI, dan PIi pada HIV 1 dari pasien gagal terapi setelah mendapat enam bulan terapi antiretrovirus di RSUPN dr Ciptomangunkusumo periode September 2013 - Maret 2014 = Hiv drug resistance after failure of 6 months first line therapy in RSUPN dr Ciptomangunkusumo September 2013 to March 2014

"Latar Belakang : Implementasi penggunaan terapi antiretrovirus aktif (highly active antiretroviral therapy/HAART) di Indonesia meningkat sejak tahun 2004. Namun demikian, perlu disadari bahwa resistensi obat HIV, salah satu konsekuensi pemberian antiretrovirus, dapat menurunkan keberhasilan terapi. Ketersediaan data mengenai resistensi terhadap obat golongan NRTI, NNRTI dan PI dapat memberi keuntungan dalam program pengendalian dan pencegahan HIV/AIDS nasional.

Tujuan : Penelitian ini dilakukan untuk mengetahui profil resistensi genotip HIV-1 terhadap antiretrovirus pada pasien terinfeksi HIV-1 yang gagal terapi lini pertama.

Metode : Mutasi gen penyandi resistensi obat HIV dievaluasi pada pasien HIV di RSUPN Dr. Ciptomangunkusumo, Jakata, setelah mengalami gagal terapi lini pertama. Pasien dengan viral load > 200 kopi/ml setelah enam bulan terapi antiretrovirus dimasukkan dalam penelitian ini. Hasil resistensi secara genotip dan subtipe HIV-1 diinterpretasi menggunakan Viroseq dan database Stanford DR.

Hasil : Sebelas pasien diperoleh selama periode penelitian dengan nilai tengah usia 31 tahun, 54,55 % pasien laki – laki dan sebaran transmisi yaitu heteroseksual (45,45 %), homoseksual (9,09 %), pengguna jarum suntik yang tidak aman (27,27 %) dan tidak diketahui (18,18 %). Infeksi oportunistik ditemukan pada 72,73 % pasien yang didominasi oleh tuberkulosis paru. Sekitar 27,27% memiliki kepatuhan minum obat yang baik. Subtipe HIV yang ditemukan 81,81 % CRF01_AE, 9,09% C dan 9,09 % tidak dapat dinilai. Nilai tengah hitung sel CD4(+) dan viral load sebesar 116 (6 - 274) sel/mm3 and 104.000 (385 - 326.595) kopi/ml. Resistensi secara genotipik ditemukan pada seluruh pasien gagal terapi. Berdasarkan rejimen antiretrovirus yang diterima, ditemukan manifestasi resisten terhadap rejimen lamivudine (90%), tenofovir (83%), nevirapine (100%) dan efavirenz (100%). Menarik untuk diperhatikan bahwa tidak ditemukan manifestasi resistensi terhadap zidovudine, termasuk pada empat pasien HIV/AIDS yang mendapatkan zidovudine dalam rejimen terapinya. Mutasi NRTI yang banyak ditemukan adalah M184VI dan K65R, sedangkan mutasi NNRTI adalah Y181CFGVY, K103N, A98AG, E138GQ dan G190AGS. Tidak ditemukan mutasi mayor terhadap PI.

Kesimpulan : Pada penelitian ini ditemukan proporsi resistensi obat HIV yang cukup tinggi. Hal ini memperkuat urgensi monitoring virologi, survey resistensi obat HIV serta akses pilihan terapi yang sesuai pada kasus gagal terapi.

Background : The administration of highly active antiretroviral therapy (HAART) has rapidly increased in Indonesia since 2004. The emergence of HIV-1 drug resistance, however, may limit the benefits of antiretroviral therapy in settings with limited laboratory monitoring and drug options. The availability of data concerning resistance towards NRTI, NNRTI, and PI will be beneficial for the national HIV/AIDS prevention and control program.
Objective : To determine genotypic resistance profiles in HIV-1 infected patients failing first line therapy.
Methods : HIV drug resistance mutations were assessed among patients from RSUPN Dr. Ciptomangunkusumo, Jakarta, following failure of their first line antiretroviral therapy. Virology failure was defined as value > 200 copies/ml after six months therapy. Genotypic resistance results and HIV-1 subtype were interpreted by Viroseq and Stanford DR database.
Results : A total of 11 adults were included. Median (IQR) age was 31 years, 54,55 % were male and mode of transmission were heterosexual (45,45 %), MSM (9,09 %), IVDU (27,27 %) and unknown (18,18 %). Opportunistic infections were found in 72,73% patients and TB were the most common infection. Only 27,27 % patients have good adherence. HIV subtypes were 81,81 % CRF01_AE, 9,09% C and 9,09 % undefined. Median (IQR) CD4(+) T-cell count and HIV-RNA were 116 (6 - 274) cells/mm3 and 104.000 (385 - 326.595) copies/ml, respectively. All patients with virological failure were resistant to at least one antiretroviral drug. Genotypic resistance towards the antiretroviral drugs being used was observed in lamivudine (90%), tenofovir (83%), nevirapine (100%) dan efavirenz (100%). It is interesting that no zidovudine resistance were found, including in four patients receiving zidovudine in their HAART. The common NRTI mutations were M184VI and K65R, while NNRTI mutations were Y181CFGVY, K103N, A98AG, E138GQ and G190AGS. No mayor PI mutations were found.
Conclusion : Our study found a high proportion of drug resistance and supports the need for appropriate virology monitoring and HIV drug resistance survey in clinical practice and access to drug options in case of virology failure."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

SP-Pdf

UI - Tugas Akhir Universitas Indonesia Library

Novie Rahmawati Zirta

Karakteristik klinis Tuberkulosis Ekstra Paru pada pasien dengan dan tanpa infeksi Human Immudeficiency Virus di Rumah Sakit Cipto Mangunkusumo = Clinical characteristics of extrapulmonary tuberculosis in patients with and without human immudeficiency virus infection at cipto mangunkusumo hospital

"Latar Belakang: Angka kejadian Tuberkulosis Ekstra Paru (TBEP) lebih tinggi pada pasien dengan infeksi HIV. Pasien TBEP dengan infeksi HIV berisiko mengalami perburukan yang cepat dan angka kematian yang tinggi. Oleh karena nya perlu diketahui karakterisitik klinis setiap jenis TBEP agar dapat mendeteksi HIV dan memulai tatalaksana TBEP lebih dini.

Tujuan: Mengetahui pola demografi pasien TBEP dan mengetahui karakteristik klinis TBEP pada pasien HIV positif dan HIV negatif.

Metode: Penelitian ini dilakukan dengan desain potong lintang dengan menggunakan data sekunder dari rekam medis pasien TBEP di seluruh RSCM baik rawat jalan maupun rawat inap selama tahun 2008-2012. Semua data dikumpulkan dan diseleksi. Kriteria inklusi penelitian ini adalah pasien TBEP dewasa dan memiliki data rekam medis yang lengkap serta dilakukan pemeriksaan Elisa anti HIV. Data yang terkumpul diolah secara deskriptif dengan menggunakan piranti lunak SPSS.

Hasil: Penelitian ini mendapatkan 620 pasien TBEP yang terdiri dari 75,97% dengan HIV positif dan 24,03% dengan HIV negatif. Kelompok usia terbanyak 18-40 tahun. Jenis kelamin pria didapat sebesar 76,6%. Sebagian besar (57,7%) berpendidikan SMA dan sederajatnya dan 46,13% tidak bekerja. Distribusi organ terbanyak pada kelompok HIV positif adalah limfadenitis TB ( 42,59%) dan pada kelompok HIV negatif adalah meningitis TB (36,18%). Gambaran klinis sistemik terbanyak adalah penurunan berat badan, demam lama, dan lemah/lemas. Karakteristik klinis tiap jenis TBEP pada kelompok HIV positif dan HIV negatif pada umumnya serupa dan keluhan terbanyak adalah nyeri.

Simpulan : Proporsi TBEP pada pasien HIV positif lebih banyak dari pada HIV negatif. Pola demografi TBEP adalah sebagian besar pria, kelompok usia 18-40 tahun, berpendidikan SMA dan sederajatnya, sudah menikah, dan tidak bekerja. Karakteristik klinis setiap jenis TBEP pada pasien HIV positif dan HIV negatif serupa.

Background: Prevalence of Extrapulmonary TB (EPTB) increases along with an escalated number of HIV infection. Patients with EPTB with HIV infection are at risk of having rapid deterioration and higher death rate. Therefore, it is important to identify clinical characteristics of each EPTB in both HIV positive and negative patients allowing early EPTB management and thus decreasing its mortality rate.
Objectives: To recognize the demographic pattern of EPTB patients and identify clinical characteristics of EPTB in HIV positive and negative patients.
Methods: This was a cross sectional study that utilized secondary data from medical records of EPTB patients from all units in RSCM, both outpatient and inpatient during a period from 2008 - 2012. Data were gathered and selected. All EPTB patients who had complete medical record and had anti HIV ELISA examined were included in this study. Gathered data were processed descriptively by using SPSS software to be presented.
Result: This study obtained data from 620 EPTB patients consisted of 75,97% with HIV positive and 24,03% with HIV negative. Most patients were in 18 - 40 year-old age group, 70% were male, 57,7% had education at senior high school or equivalent level while 46,13% were unemployed. Distribution of organ involvement in HIV positive were lymphadenitis ( 42,59%) and in HIV negetive were meningitis (36,18%). Systemic clinical presentation were mostly weight loss, prolonged fever, and weakness/fatigue. Clinical characteristics in each EPTB both in HIV positive and negative were generally similar. The most common symptoms were pain.
Conclusion: EPTB proportion in HIV positive patients were higher than in HIV negative. Demographic pattern of EPTB were mostly male, age group 18 - 40 year-old, senior high school or equivalent level and unemployed. Clinical characteristics from each type of EPTB in HIV positive and negative were similar."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

SP-Pdf

UI - Tugas Akhir Universitas Indonesia Library

Hery Agung Samsu Alam

Profil pasien HIV periode 2004-2013 yang tetap berobat sampai akhir 2014 di Unit Pelayanan Terpadu HIV RS Cipto Mangunkusumo Jakarta = Profiles of HIV patients during the period of 2004 to 2013 who continued their medical treatment until the end of 2014 in HIV Integrated Service Unit Cipto Mangunkusumo Jakarta

"ABSTRAK

Latar Belakang: Kesinambungan berobat memiliki peran penting dalam

keberhasilan tatalaksana pasien HIV. Hingga saat ini, belum dilakukan penelitian

untuk melihat proporsi pasien yang masih tetap berobat di UPT HIV RSCM

maupun profil dari pasien-pasien tersebut.

Tujuan: Mengetahui proporsi dan profil pasien yang masih tetap berobat di UPT

HIV RSCM.

Metode: Studi dengan metode potong lintang pada pasien HIV yang baru

terdiagnosis dan berobat di UPT HIV RSUPNCM dalam periode Januari 2004 -

Desember 2013. Data diperoleh melalui ekstraksi data sekunder yang berasal dari

rekam medik. Penelitian dilakukan terhadap pasien HIV yang berusia diatas 18

tahun dan belum menjalani terapi ARV. Pasien yang tetap berobat sampai akhir

2014 didefinisikan sebagai pasien yang tetap kontrol ke poliklinik sejak awal pasien

datang ke UPT HIV hingga minimal tiga bulan sebelum akhir Desember 2014.

Hasil: Sebanyak 4949 subjek diikutkan dalam penelitian ini. Didapatkan proporsi

pasien yang tetap berobat sampai akhir 2014 adalah 23% (1136 subjek). Selain itu,

subjek dengan jenis kelamin wanita (26,6%), berusia ≥35 tahun (usia 35-44 tahun

sebesar 25,5% dan ≥45 tahun sebesar 35,5%), pendidikan terakhir diatas SMU

(26,8%), menikah/dengan pasangan (25%), beralamat di Bodetabek (26,1%),

stadium klinis IV (28,3%), memiliki angka CD4 awal 201-350 sel/mm3 (35%), dan

bukan penasun (28%) adalah subjek terbanyak yang tetap berobat sampai akhir

2014.

Simpulan: Proporsi pasien yang tetap berobat sampai akhir 2014 adalah 23% (1136

subjek). Selain itu, pasien dengan jenis kelamin wanita, berusia ≥35 tahun,

pendidikan terakhir diatas SMU, menikah/tinggal dengan pasangan, beralamat di

Bodetabek, stadium klinis IV, memiliki angka CD4 awal 201-350 sel/mm3, dan

bukan penasun merupakan kelompok subjek terbanyak yang tetap berobat sampai akhir 2014.ABSTRACT

Background: Continued medical treatment serves an important role in the

successful management of patients with HIV. Until this present day, there has never

been any research which seeks to examine the proportion of patients who continue

their medical treatment at HIV Integrated Service Unit of National Central General

Hospital Cipto Mangunkusumo (RSUPNCM) and the profiles of those patients.

Objectives: To discover the proportion and to generate the profiles of patients who

continued their medical treatment at HIV Integrated Service Unit, RSUPNCM.

Methods: This research was conducted by applying the cross-sectional method on

patients who were diagnosed with HIV and were subsequently undergoing medical

treatment at HIV Integrated Service Unit, RSUPNCM, during the period of January

2004 to December 2013. Data were obtained by extracting secondary data in the

form of medical records. The subjects of the research are HIV patients who are

more than 18 years of age and have not undergone anti-retroviral (ARV) treatments.

Patients who continued their medical treatment until the end of 2014 are defined as

patients who have undergone medical treatment at the polyclinic starting from their

first visit to HIV Integrated Service Unit until at least three months prior to the end

of December 2014.

Results: As many as 4949 subjects participated in this research. We found that the

proportion of patients who continued their medical treatment until the end of 2014

is 23% (1136 subjects). In addition to that, we also found that female subjects

(26.6%) who are ≥35 years of age (25.5% for those between 35 and 44 years of age

and 35.5% for those ≥45 years of age); whose education is higher than Senior High

School level (26.8%); who have married or live with their respective partners

(25%); who reside in Bogor, Depok, Tangerang, or Bekasi areas (26.1%); who have

reached clinical stage IV (28.3%); whose initial CD4 count is 201?350 cells/mm

(35%); and who are not injecting drug users (IDUs) (28%) constitute the largest

group of subjects who continued their medical treatment until the end of 2014.

Conclusion: The proportion of patients who continued their medical treatment until

the end of 2014 is 23% (1136 subjects). In addition to that, female patients who are

≥35 years of age; whose education is higher than Senior High School level; who

have married or live with their respective partners; who reside in Bogor, Depok,

Tangerang, or Bekasi areas; who have reached clinical stage IV (28.3%); whose

initial CD4 count is 201?350 cells/mm

, and who are not injecting drug users

(IDUs) constitute the largest group of subjects who continued their medical

treatment until the end of 2014.;Background: Continued medical treatment serves an important role in the