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"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.

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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."

"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."

"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.

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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. "

"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.

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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."

"ABSTRAKSkripsi ini membahas evaluasi hasil terapi ARV terhadap perubahan jumlah CD4 dan berat badan, serta terapi OAT terhadap perubahan berat badan pada pasien koinfeksi TB/HIV di RSCM tahun 2009. Penelitian ini dilakukan untuk mengetahui keefektifan terapi ARV dan OAT, serta melihat pengaruh karakteristik demografi terhadap perubahan berat dan jumlah CD4 pada pasien koinfeksi TB/HIV di RSCM. Desain studi yang dipakai adalah Cross sectional. Hasil penelitian membuktikan bahwa pasien yang mendapat terapi ARVmengalami peningkatan jumlah CD4 rata - rata sebesar 200,44 sel/mm3 dengan p value 0,0005 (bermakna secara statistik). Pada pengukuran berat badan, ternyata terapi ARV meningkatkan berat badan pasien rata - rata sebesar 5,12 kg dengan p value 0,0005 (bermakna secara statistik), dan pada pasien yang mendapatkanterapi OAT secara lengkap berat badan meningkat rata ? rata sebesar 4,79 kg dengan p value sebesar 0,0005 (bermakna secara statistik). Berdasarkan karakteristik demografi, bahwa pada pasien dengan kelompok umur lebih dari 30 tahun, pendidikan lebih dari SMA, sudah menikah, bekerja dan jenis kelamin laki-laki mempunyai peningkatan berat badan yang lebih tinggi, namun uji statistik tidak signifikan. Jika dilihat dari peningkatan jumlah CD4, pasien dengan kelompok umur lebih dari 30 tahun, pendidikan lebih dari SMA, sudah menikah,bekerja dan jenis kelamin perempuan mempunyai peningkatan jumlah CD4 yang lebih tinggi, namun uji statistik tidak signifikan. Maka, kesimpulannya adalah karakteristik demografi tidak mempengaruhi peningkatan berat badan maupun jumlah CD4.

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ABSTRACTThis research discusses the evaluation results of antiretroviral therapy on CD4 cell count changes and weight, and OAT therapy on weight changes in patients coinfected with TB/HIV in RSCM in 2009. The study was conducted to determine the effectiveness of ARV therapy and OAT and see the impact of demographic characteristics to changes in weight and CD4 count in patients coinfected with TB/HIV in RSCM. Study designed used was cross sectional. Research shows that patients who received antiretroviral therapy experienced an increase in mean CD4 counts average of 200,44 cell/mm3 with a p value 0.0005(statistically significant). In the measurement of body weight, ARV therapy can increase a patients weight average of 5,12 kg with a p value 0.0005 (statistically significant), and in patient receiving OAT full weight increase average of 4,79 kg with a p value of 0.0005 (statistically significant). Based on demographic characteristics, that in patients with age group over 30 years, more than high that in patients with age group over 30 years, more than high school education, married, working and male gender had a weight gain is higher, but the test was not statistically significant. If viewed from an increase in CD4 cell counts, patients with the age group over 30 years, more than high school education, married, working and women gender have increased CD4 counts are higher, but the test was not statistically significant. Thus, the conclusion is the demographic characteristics did not affect weight gain and CD4 cell count"

"Terapi antiretroviral mampu menekan replikasi HIV, mencegah morbilitas dan mortalitas. Kepatuhan pengobatan dibutuhkan untuk mencapai kesuksesan terapi, mencegah resistensi obat antiretroviral dan risiko penularan HIVDR ditengah masyarakat. Efek samping obat antiretroviral umumnya terjadi pada 3 bulan pertama setelah inisiasi yang dapat mempengaruhi kepatuhan pengobatan pasien di tahun pertama pengobatan antiretroviral. Penelitian ini bertujuan untuk mengetahui pengaruh efek samping obat antiretroviral lini pertama terhadap kepatuhan pengobatan pasien HIV/AIDS di RSPI Prof. Dr. Sulianti Saroso tahun 2010-2015. Penelitian ini merupakan studi kohort retrospektif berbasis rumah sakit dimana sebanyak 376 naïve-patient HIV/AIDS dipilih sebagai sampel dan diamati selama 12 bulan setelah inisiasi ART. Kepatuhan pengobatan diukur dengan dua metode yaitu berdasarkan self report dan ketepatan waktu ambil obat. Data dianalisa dengan menggunakan cox proportional hazard regression dengan perangkat lunak STATA12. Hasil penelitian menunjukkan bahwa efek samping obat ARV lini pertama berpengaruh terhadap kepatuhan minum obat (RR12=1,45, 95% CI 1,009?2,021 dan RR34=0,85, 95% CI 0,564-1,273) namun tidak berpengaruh terhadap kepatuhan ambil obat (RR12=1,23, 95% CI 0,851-1,839 dan RR34=0,70, 95% CI 0,437-1,108).

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Antiretroviral therapy suppresses HIV replication, preventing morbidity and mortality. Adherence to antiretroviral therapy is needed to achieve successful treatment, prevent resistance to antiretroviral drugs and the risk of transmission of HIVDR in the community. The side effects of antiretroviral drugs generally occur in the first 3 months after initiation that could affect adherence in the first year of antiretroviral treatment. The aim of this study analyzed the effect of first-line antiretroviral side effect and adherence of HIV/AIDS patients in RSPI Prof. Dr. Sulianti Saroso period 2010 until 2015.

This study is hospital based retrospective cohort. A total of 376 HIV/AIDS naïve-patient had been selected as samples. Adherence was measured by two methods, based on self report and drug pick-up. Data was analyzed using cox proportional hazard regression with STATA12 software. Based on self report, HIV/AIDS patients who experience first-line ARV drugs side effect significantly associated with non-adherent (RR12=1.45, 95% CI 1.009 to 2.021 and RR34=0.85, 95% CI 0.564 to 1.273). Based on drug pick up, patients who experience first-line ARV drugs side effect not significantly associated with non-adherent (RR12=1.25, 95% CI 0.851 to 1.839 and RR34=0.70, 95% CI 0.437 to 1.108)."

"Tuberkulosis (TB) dan Human Immunodeficiency Virus (HIV) menjadi beban utama penyakit menular terutama di negara-negara berpenghasilan rendah. Pada pasien penderita Tuberkulosis dengan adanya infeksi penyerta seperti koinfeksi HIV, diestimasikan akan meningkatkan risiko terjadinya drug-induced liver injury (DILI) akibat OAT sebanyak 4 kali lipat. Dilakukan pemantauan terapi obat ini untuk menganalisis masalah terkait obat (MTO)/ Drug’s Related Problem (DRP) yang terjadi pada pengobatan pasien dan memberikan rekomendasi tindak lanjut menggunakan metode SOAP. Diperoleh hasil bahwa pasien memiliki diagnosis ikterus obstruktif, anemia normositik normokrom, hiponatremia hipoosmolar euvolemik, Dili et causa OAT, HIV on ARV, TB on OAT dan terdapat interaksi obat kategori antara sukralfat dengan dolutegravir yang menyebabkan Sukralfat menurunkan efek dari dolutegravir dengan pengikatan kation dlm saluran GI. Hasil analisis DRP disajikan dalam SOAP sebagai komunikasi tertulis untuk menyampaikan rekomendasi kepada dokter penanggung jawab (DPJP).

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Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are the main burden of infectious diseases, especially in low-income countries. In patients suffering from Tuberculosis with accompanying infections such as HIV co-infection, it is estimated that the risk of drug-induced liver injury (DILI) due to OAT will increase by 4 times. This drug therapy monitoring is carried out to analyze drug-related problems (MTO)/Drug-Related Problems (DRP) that occur during patient treatment and provide follow-up recommendations using the SOAP method. The results showed that the patient had a diagnosis of obstructive jaundice, normochromic normocytic anemia, euvolemic hypoosmolar hyponatremia, Dili et causa OAT, HIV on ARV, TB on OAT and there was a major category of drug interaction between sucralfate and dolutegravir which caused Sucralfate to reduce the effect of dolutegravir by binding cations in GI tract. The results of the DRP analysis are presented in SOAP as written communication to convey recommendations to the doctor in charge (DPJP)."

"[ABSTRAKLatar Belakang: Terapi antiretroviral (ARV) terbukti secara efektif dapat menekan replikasi HIV. Pengukuran viral load (VL) merupakan prediktor yang lebih baik dibanding kriteria klinis atau imunologis untuk menilai kegagalan atau keberhasilan terapi ARV. Karena keterbatasan sumber daya, maka pemeriksaan VL tidak selalu mudah untuk diakses oleh pasien HIV yang mendapat terapi ARV sehingga perlu untuk diketahui faktor-faktor pada pasien yang dapat memprediksi terjadinya kegagalan virologis.Tujuan: Mengetahui faktor prediktor kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama sesuai paduan ARV terbaru di Indonesia.Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien HIV rawat jalan dewasa di RSCM yang mulai terapi ARV lini pertama selama periode Januari 2011-Juni 2014. Pasien HIV yang mempunyai data VL 6-9 bulan setelah mulai terapi ARV dengan kepatuhan berobat baik dimasukkan sebagai subjek penelitian. Kegagalan virologis dinyatakan sebagai nilai VL ≥ 400 kopi/mL setelah minimal 6 bulan terapi ARV dengan kepatuhan berobat baik. Paduan ARV yang digunakan terdiri dari dua NNRTI (salah satu dari TDF/AZT/d4T ditambah 3TC) dengan satu NNRTI (NVP atau EFV). Usia, faktor risiko penularan HIV, stadium klinis HIV menurut WHO, ko-infeksi TB, indeks massa tubuh, kadar hemoglobin, dan jumlah CD4 awal terapi serta basis paduan terapi ARV merupakan variabel yang diteliti pada penelitian ini.Hasil: Terdapat 197 pasien sebagai subjek penelitian ini. Kegagalan virologis didapatkan pada 21 pasien (10,7%). Semua variabel yang diteliti belum terbukti dapat memprediksi kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama dengan adherens baik. Terdapat peningkatan risiko kegagalan virologis pada pasien dengan usia yang lebih muda, faktor risiko penasun, stadium klinis lanjut, adanya ko-infeksi TB, dan paduan ARV TDF+3TC+NVP tetapi tidak bermakna secara statistik.!!Simpulan: Dari variabel yang diteliti, tidak didapatkan variabel yang terbukti sebagai prediktor awal kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama dengan adherens baik.

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ABSTRACTBackground: Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate failure or success of ART. However, in the country with limited resources, VL measurement is not easily accessible by HIV patients receiving ARV therapy therefore it is necessary to know which factors in the patients that can predict virological failure.Objectives: To know early predictive factor of virological failure in HIV patients receiving recent first line ARV therapy regimen in IndonesiaMethods: This study was a retrospective cohort study among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo General Hospital that started ARV therapy during periode January 2011-June 2014. HIV patients with good adherence that have VL data 6-9 months after initiation of ARV therapy were included in this study. Virological failure was defined as VL ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. ARV regimen used in this study consist of two NRTI (one of TDF/AZT/d4T plus 3TC) combined with one NNRTI (NVP or EFV). Age, risk factor for HIV infection, HIV clinical stage, HIV- TB co-infection, baseline CD4 value, hemoglobin level, body mass index, and ARV therapy regimen at the time of initiation were among the variables that analyzed in this study.Results: There are 197 patients as subjects in this study. Virological failure was found in 21 patients (10,7%). All the variables included in this study can not predict virological failure in HIV patients receiving first line ART with good adherence. There is increase risk of virological failure in patients with younger age, IDU as risk factor for HIV infection, late clinical stage, TB co-infection, and ARV regimen TDF+3TC+NVP but not reaching statistically significant.Conclusion: There is no variable in this study proved to be early predictive factor for virological failure in HIV patients receiving first line ART with good adherence.;Background: Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate failure or success of ART. However, in the country with limited resources, VL measurement is not easily accessible by HIV patients receiving ARV therapy therefore it is necessary to know which factors in the patients that can predict virological failure.Objectives: To know early predictive factor of virological failure in HIV patients receiving recent first line ARV therapy regimen in IndonesiaMethods: This study was a retrospective cohort study among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo General Hospital that started ARV therapy during periode January 2011-June 2014. HIV patients with good adherence that have VL data 6-9 months after initiation of ARV therapy were included in this study. Virological failure was defined as VL ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. ARV regimen used in this study consist of two NRTI (one of TDF/AZT/d4T plus 3TC) combined with one NNRTI (NVP or EFV). Age, risk factor for HIV infection, HIV clinical stage, HIV- TB co-infection, baseline CD4 value, hemoglobin level, body mass index, and ARV therapy regimen at the time of initiation were among the variables that analyzed in this study.Results: There are 197 patients as subjects in this study. Virological failure was found in 21 patients (10,7%). All the variables included in this study can not predict virological failure in HIV patients receiving first line ART with good adherence. There is increase risk of virological failure in patients with younger age, IDU as risk factor for HIV infection, late clinical stage, TB co-infection, and ARV regimen TDF+3TC+NVP but not reaching statistically significant.Conclusion: There is no variable in this study proved to be early predictive factor for virological failure in HIV patients receiving first line ART with good adherence., Background: Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate failure or success of ART. However, in the country with limited resources, VL measurement is not easily accessible by HIV patients receiving ARV therapy therefore it is necessary to know which factors in the patients that can predict virological failure.Objectives: To know early predictive factor of virological failure in HIV patients receiving recent first line ARV therapy regimen in IndonesiaMethods: This study was a retrospective cohort study among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo General Hospital that started ARV therapy during periode January 2011-June 2014. HIV patients with good adherence that have VL data 6-9 months after initiation of ARV therapy were included in this study. Virological failure was defined as VL ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. ARV regimen used in this study consist of two NRTI (one of TDF/AZT/d4T plus 3TC) combined with one NNRTI (NVP or EFV). Age, risk factor for HIV infection, HIV clinical stage, HIV- TB co-infection, baseline CD4 value, hemoglobin level, body mass index, and ARV therapy regimen at the time of initiation were among the variables that analyzed in this study.Results: There are 197 patients as subjects in this study. Virological failure was found in 21 patients (10,7%). All the variables included in this study can not predict virological failure in HIV patients receiving first line ART with good adherence. There is increase risk of virological failure in patients with younger age, IDU as risk factor for HIV infection, late clinical stage, TB co-infection, and ARV regimen TDF+3TC+NVP but not reaching statistically significant.Conclusion: There is no variable in this study proved to be early predictive factor for virological failure in HIV patients receiving first line ART with good adherence.]"

"Latar Belakang: Gangguan penglihatan adalah gejala kedua yang sering muncul pada tumor otak setelah nyeri kepala. Gejala gangguan penglihatan yang paling sering terjadi pada tumor otak adalah penurunan visus atau tajam penglihatan (low vision sampai kebutaan), sedang tanda yang paling sering dijumpai adalah atrofi n. optikus dan papilledema. Penurunan tajam penglihatan yang dialami penderita tumor otak dapat sangat berat hingga berupa kebutaan. Sampai saat ini belum terdapat data angka kejadian gangguan penglihatan sampai kebutaan pada tumor otak di Indonesia. Metode: Sebagai studi potong lintang analitik, dikumpulkanlah data pasien penderita tumor otak di atas usia 6 tahun yang datang berobat ke poliklinik Bedah Saraf FKUIRSCM pasien September 2013 hingga Februari 2014 dari catatan rekam medis. Hasil: Jumlah pasien tumor otak yang mengalami buta sebanyak 37 orang (34,6 %) dengan usia rata-rata 45,3 (SD 11,3 tahun). Sebesar 86,5 % penderita berada pada usia produktif 15-54 tahun. Dari 37 pasien tumor otak yang buta terlihat proporsi gejala penyerta terbesar adalah sefalgia (terutama sefalgia kronis), diikuti oleh gangguan oftalmologi lain. Data pemeriksaan funduskopi hanya ditemukan pada kurang dari 50 % penderita, dengan temuan yang terbanyak adalah papil atrofi. Kesimpulan: Besar angka kebutaan pada pasien tumor otak menunjukkan bahwa kondisi ini tidak hanya menjadi masalah medis saja tetapi juga masalah sosial yang serius. Banyaknya jumlah pasien tanpa data funduskopi menandakan masih lemahnya standar pemeriksaan neurooftalmologi ataupun pencatatan yang ada saat ini, padahal pemeriksaan funduskopi berperan sangat penting mendeteksi dini kejadian tumor otak pada pasien dengan gangguan penglihatan.

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Background: Vision impairment is the second most common symptom in brain tumor after headache, with decreased visual acuity or low vision as its most common manifestation, and optic nerve atrophy and papilledema as its most common sign. Blindness may be the final outcome of this impairment. Until now, there is no data regarding the prevalence of vision impairment in brain tumor patient in Indonesia.

Method: As a analytic cross-sectional study, data is collected from the medical record regarding brain tumor patient above the age of 6 years old who were seen in the neurosurgery facility in FKUI-RSCM from September 2013 to February 2014.

Result: As much as 37 patient (34,6%) brain tumor patient were found to be blind; mean age was 45,3 years old (SD 11,3 years old), with 86,5% patient was in the productive age 15-54 years old. The commonest related symptoms was headache (especially chronic headache), followed by other ophthalmologic symptoms. Funduscopy data was found only in less than 50% patient; the commonest finding was optic nerve atrophy.

Conclusion: Blindness rate in brain tumor patient is not just a medical issue, but also a social one. Funduscopy usage must be encouraged more to provide early detection for brain tumor patient with vision impairment."