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"HIV exposure among health workers is still quite rare, including in Indonesia. Nevertheless, with the increase in new HIV cases due to intravenous drug abuse, there should be more health workers caring for HIV cases. To avoid exposure, universal precaution has to be implemented. If exposure occurs, the HIV stale of the patient, as the source of body fluid should be determined, while the exposed health care worker needs to undergo counseling. Anti retroviral agents should be administered prior to 36 hours following exposure. Sero-conversion monitoring must be performed during exposure, also 3 months, 6 months, and 12 months following exposure- There have been 9 cases of HIV exposure due to accidents among health workers reported to the Working Group on AIDS (Kelompok Studi Khusus - Pokdiksus AIDS) Faculty of Medicine of the University of Indonesia - Cipto Mangunkusumo General Central National Hospital. Six of them received AZT prophylactic treatment, while the remaining 3 chose not to use any prophylactic treatment. After six months following exposure, all anti HIV test were negativeThe number of HIV cases in the last two years has shown a tremendous increase. AT the end of February 2002, the Department of Health recorded 2/50 cases of HIV/AIDS in Indonesia.1 As new cases increase among intravenous drug abuse, the number of HIV cases is estimated to increase further in the future, bearing in mind that experts have estimated that number of drug abusers in Indonesia have reached 2 million people. Those infected with HIV, especially those already in the AIDS stage, often require hospitalization for treatment of opportunistic infections. Thus, health workers have to prepare themselves to face the increasing problem of HIV infection.To avoid contagion of HIV, Hepatitis B, and Hepatitis C thai may reside in the patient's body fluids to another person, the Center for Disease Control (CDC> recommends universal precaution. This guideline from C DC should be continuously distributed to allow health workers to continue to work with a feeling of security.Nevertheless, there is still the possbility of accidents among health workers at work in the form of needle prick or direct exposure to body fluids from an HIV-infected individual."

"This is the first report of HIV drug resistance in RSUPN Dr. Cipto Mangunkusumo. We tested We reviewed eleven new cases of HIV patients who had virologic failure after 6 months first-line antiretroviral therapy. With the sequencing method, analysis of gene mutations encoded HIV drug resistance. Genotypic resistance results and HIV-1 subtype were interpreted by Stanford DR database. Of ten plasma samples that were successfully amplified and sequenced, all samples 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. Based on these findings, we 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."

"ABSTRAKPendahuluan:Gejala klinis tuberkulosis (TB) pada HIV seringkali tidak khas sehingga diagnosis menjadi sulit. Hal ini mengakibatkan underdiagnosis atau overdiagnosis dengan konsekuensi meningkatnya morbiditas dan mortalitas. Hingga saat ini, gejala dan tanda yang berhubungan dengan diagnosis TB paru belum banyak diteliti. Penelitian ini dilakukan untuk mengetahui nilai diagnostik dari gabungan gejala (batuk, penurunan berat badan, demam, dan rontgen toraks) dalam diagnosis TB paru pada pasien HIV dan nilai tambah biakan MGIT 960 dalam meningkatkan kemampuan diagnosis TB paru pada pasien HIV.Metode:Penelitian potong lintang terhadap pasien HIV dengan kecurigaan TB yang datang ke Poli HIV atau pasien ruang rawat Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta dari Oktober 2011 hingga April 2012. Hubungan gejala klinis dan radiologis dengan diagnosis TB (biakan Lowenstein Jensen) dianalisis dengan regresi logistik. Kemudian ditentukan kontribusi masing masing determinan diagnosis terhadap diagnosis TB. Kemampuan biakan MGIT 960 dalam menegakkan diagnosis TB dinilai dengan membuat kurva ROC dan menghitung AUC. Analisis data dilakukan dengan menggunakan program SPSS versi 16.0.Hasil:Subjek penelitian umumnya laki-laki (63%) dengan median usia 32 (rentang 18-52) tahun, status gizi baik (43%), CD4 <50 μl sebanyak 48%. Risiko transmisi terbanyak adalah pengguna narkoba suntik (penasun) (51%). Dari analisis multivariat, demam dan penurunan berat badan mancapai kemaknaan secara statistik. Nilai area under curve (AUC) manifestasi klinis adalah 71,9%. Penambahan biakan BTA MGIT 960 akan meningkatkan AUC 24,9% menjadi 95,7%.Simpulan:Gabungan gejala demam dan penurunan berat badan mampu memprediksi diagnosis TB paru pada pasien HIV. Penambahan biakan BTA MGIT 960 bermanfaat meningkatkan kemampuan gabungan gejala klinis dalam diagnosis TB paru pada pasien HIV."

"Perubahan tunika intima media (TIM) karotis dan flow mediated dilatation (FMD) dapat digunakan sebagai pemeriksaan untuk mengetahui aterosklerosis dini. Pada ODHA TIM karotis dan FMD dapat dipengaruhi oleh inflamasi kronik akibat infeksi HIV itu sendiri, efek samping terapi ARV, dan koinfeksi virus atau bakteri lain. Oleh karena itu, penelitian ini menelaah kinetika penanda inflamasi (CRP, ICAM-1 dan sTNFR), kondroitin sulfat (KS) serta antibodi CMV, mengorelasikannya dengan perubahan TIM karotis dan FMD pada ODHA yang memulai terapi ARV serta dibandingkan dengan kontrol sehat setelah 60 bulan terapi ARV.Desain penelitian kohort prospektif dan cross-sectional. Subjek penelitian didapatkan dengan consecutive sampling dari Januari 2013 sampai Desember 2014, diamati dalam 3 kurun waktu selama 60 bulan di RSUPN Dr. Cipto Mangunkusumo. Dilakukan pemeriksaan USG pembuluh darah karotis pada semua subjek, diamati perubahan ketebalan TIM karotis, FMD, kadar CD4, indeks massa tubuh, kadar CRP, ICAM-1, sTNFR, KS, dan antibodi CMV setiap periode pengamatan. Data dianalisis menggunakan uji Mann Whitney U, Wilcoxon, Spearman’s correlation, Pearson’s correlation dan multiple linear regression.Tidak didapatkan perubahan TIM karotis setelah dilakukan terapi ARV selama 12 bulan dan 60 bulan. Tidak ada perbedaan bermakna untuk TIM karotis dan FMD antara ODHA dengan kontrol sehat. ICAM-1 memiliki korelasi dengan TIM karotis pada kunjungan awal sebelum terapi dan KS memiliki korelasi dengan TIM karotis setelah 60 bulan terapi ARV. FMD memiliki korelasi negatif dengan KS dan antibodi CMV lysate pada ODHA, sedangkan pada kontrol sehat FMD memiliki korelasi negatif dengan sTNFR dan KS, namun memiliki korelasi kuat dengan antibodi CMV gB.Inflamasi kronik pada ODHA tidak menyebabkan perubahan TIM karoti. KS dan antibodi CMV lysate dapat memengaruhi nilai FMD pada ODHA. Pada kontrol sehat, KS dan sTNFR bisa memengaruhi nilai FMD, namun antibodi CMV gB bisa berfungsi sebagai faktor pelindung.

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Carotid intima-media thickness (CIMT) and flow mediated dilatation (FMD) used to detect early atherosclerosis. In people living with hiv/aids (PLWH), CIMT and FMD could be influenced by chronic inflammation affected HIV infection, ART and co-infection. We did the research to study the kinetic of inflammation biomarkers (CRP, ICAM-1 and sTNFR), chondroitine sulfate (CS) and CMV reactive antibodies, to find correlation for CIMT and FMD starting ART and compare to healthy control (HC) after 60 months.

This was a cohort prospective study and repeated cross sectional. The subjects were collected from January 2013 until December 2014, follow up to 60 months. Every visit we did USG for carotid artery and FMD at brachial artery, CD4, BMI, CRP, ICAM-1, sTNFR, CS and CMV antibodies level were also measured. Data were analyzed using Mann Whitney U, Wilcoxon, Spearman’s correlation, Pearson’s correlation and multiple linear regression.

There were no differences in CIMT changes in 60 years follow up. There were no differences of CIMT and FMD between PLWH and HC. ICAM-1 had a correlation with CIMT before starting ARV therapy and CS had a correlation with CIMT after 60 months of ARV therapy. FMD had a negative correlation with CS and CMV Lysate antibody for PLWH. FMD had negative correlation to CS and sTNFR but strong correlation to CMV gB antibody in HC.

Chronic inflammation in PLWH did not cause CIMT changes. CS and CMV Lysate antibody may influenced FMD in PLWH, but for HC, CS and sTNFR may influenced FMD, but CMV gB antibody could be a protective factor.

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