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"Liver disease has been identified as a leading cause of death in HIV-infected patients since the introduction of highly active antiretroviral therapy (HAART) in 1996. The HIV treatment community has been caught largely unaware of this emerging dilemma. Many HIV care providers are ill-equipped to understand and interpret liver injury patterns, or to provide comprehensive care and management for viral coinfections which they are not familiar with.HIV and liver disease provides a comprehensive update of the field covering the epidemiology, pathogenesis, management and treatment of liver disease in patients with HIV infection. The volume will help HIV care providers understand and interpret liver injury patterns, and/or provide comprehensive care and management for viral coinfections. Gastroenterologists and hepatologists will gain an understanding of complex drug regimens that are used to treat HIV and which may impact HCV and HBV treatment. Written by expert clinicians and researchers across multiple disciplines, HIV and Liver Disease will be of great value to gastroenterologists, hepatologists, infectious disease practitioners, as well as other health care providers who provide care or participate in research in the field of HIV."

"he fourth edition of this authoritative text covers every aspect of liver disease affecting infants, children, and adolescents. As in the previous editions, it offers an integrative approach to the science and clinical practice of pediatric hepatology and charts the substantial progress in understanding and treating these diseases. All of the chapters are written by international experts and address the unique pathophysiology, manifestations, and management of these disorders. This edition of the landmark text features extended coverage of viral hepatitis, metabolic liver disease, fatty liver disease, and liver transplantation, including a new chapter on post-transplant care and outcomes. All of the chapters have been updated to reflect changing epidemiology and recent advances in molecular medicine and genomics. With the continued evolution of pediatric hepatology as a discipline, this text remains an essential reference for all physicians involved in the care of children with liver disease."

"Latar belakang : Seiring dengan semakin efektifnya terapi Antiretroviral (ARV) pasien HIV memiliki harapan hidup lebih lama, morbiditas dan mortalitas penyakit HIV yang tidak berhubungan dengan Acquired Immunodeficiency Syndrome semakin meningkat. Non-alcoholic Fatty Liver Disease (NAFLD) telah dikenali sebagai penyakit hati tersering yang mempengaruhi lebih dari seperempat jumlah populasi global dan jumlahnya semakin meningkat di Indonesia. Pasien yang terinfeksi HIV memiliki risiko lebih tinggi untuk terkena NAFLD. Penelitian ini bertujuan untuk mendapatkan informasi tentang prevalensi dan faktor yang berhubungan dengan NAFLD pada pasien HIV dalam pengobatan antiretroviral (ARV) tanpa hepatitis viral kronis. Metode: Penelitian ini merupakan studi potong lintang yang melibatkan pasien HIV dalam pengobatan ARV tanpa koinfeksi virus hepatitis yang berobat di poliklinik Kelompok Studi Khusus (POKDISUS) Rumah Sakit Cipto Mangunkusumo Jakarta. NAFLD didefinisikan sebagai perlemakan di jaringan hati yang dibuktikan oleh pemeriksaan imaging transient elastography dengan Controlled Attenuation Parameter (CAP) setidaknya 238 dB/m. Perkiraan faktor-faktor yang berhubungan dengan NAFLD dianalisis dengan regresi logistik bivariat dan multivariat. Hasil: Pada penelitian ini secara keseluruhan didapatkan 105 subyek pasien HIV yang direkrut secara konsekutif. Prevalensi NAFLD didapatkan 52,4% (95% CI ±9,55). Faktor-faktor yang berhubungan dengan NAFLD pada populasi ini adalah hipertensi (PR = 3,755; 95% CI 1,218-11,575; p = 0,021) dan Index Massa Tubuh (IMT) (PR = 1,212 95% CI 1,051-1,396; p = 0,008). Faktor terkait HIV seperti CD4+ nadir, lama mendapat terapi ARV didapatkan tidak terkait NAFLD. Kesimpulan: Prevalensi NAFLD pada pasien HIV di Indonesia tinggi. NAFLD didapatkan berkaitan dengan hipertensi dan IMT, namun tidak dengan faktor-faktor terkait HIV. Penapisan non invasif untuk NAFLD sebaiknya diimplementasikan pada populasi ini untuk intervensi awal dan pencegahan komplikasi.

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Background: As HIV-infected persons experience longer life expectancies, other cause of morbidity and mortality among this group are increasingly being identified. Non-alcoholic fatty liver disease (NAFLD) has been recognized as the most common liver disease affecting more than a quarter of global population and increasing number in Indonesia. HIV-infected persons are at an increased risk of having NAFLD. This study aimed to inform prevalence and factors associated with NAFLD in HIV-infected patients without chronic viral hepatitis on antiretroviral therapy (ARV). Methods: A cross sectional study of HIV-infected person on ARV without hepatitis co-infection was done in HIV Integrated Clinic Cipto Mangunkusumo Hospital, Jakarta. NAFLD was defined as having at least 238 dB/m in transient elastography with associated Controlled Attenuation Parameter (CAP) examination. Bivariate and multivariate logistic regression analysis were applied to estimate factors associated with NAFLD Results: A total of 105 consecutive HIV infected person were included in the study analyzed. The prevalence of NAFLD was 52.4% (95% CI ±9.55). Factors related to NAFLD in this population were hypertension (PR = 3.755; 95% CI 1.218-11.575; p = 0.021) and Body Mass Index (BMI) (PR = 1.212 95% CI 1.051-1.396; p = 0.008). HIV specific variables such as nadir CD4, duration of ARV were not associated with NAFLD. Conclusion : There was a high prevalence of NAFLD among Indonesian person infected with HIV. NAFLD was associated with BMI and hypertension, but not with HIV related factors. Non-invasive screening for NAFLD should be implemented in this populaton to establish early intervention and prevent complication"

"Despite the growing number of new cases of HIV and AIDS in Indonesia, the progress ofprevention programs has been slow. Low prevalence is always stated as a reason for delayingHIV prevention programs and to justify slow progress in implementation. Prevention programsare moreover based on a high-risk group paradigm. They focus on female sex workers asresponsible for the spread of HIV, leading to its stigmatization as a hooker?s disease. This articledescribes how seropositive mothers interpret and respond to HIV and AIDS as women, in lightof the fact that most of them have not experienced full-blown AIDS. Some women had alreadyexperienced severe illnesses caused by HIV but defined their ill health by the symptoms theyexperienced, revealing that they did not really feel as if they were living with HIV and AIDS.Despite the fact that some members had died due to AIDS, many still could not believe thatthey were suffering from HIV and AIDS or that their illnesses were caused by it; rather, theirsymptoms were of other diseases such as diarrhoea, tuberculosis, or hepatitis. And thoughthey realized that their past (or present) behaviours put them at risk, they maintained thatthey were victims who had contracted the disease from their promiscuous or drug-injectinghusbands. Even when they did admit that their own behaviour had something to do with it,they did not consider HIV and AIDS as a disease but a curse from God, a punishment fortheir immoral behaviour.Keywords: Women, Infectious Disease, Interpretation, HIV and AIDS, Support Group,Indonesia"

"Latar Belakang. Lean NAFLD lebih sering ditemukan di negara Asia dan prevalensinya di Indonesia masih belum diketahui. Tingginya prevalensi, asimptomatik dan baru bergejala setelah timbul komplikasi, dan tingginya mortalitas lean NAFLD menjadikan perlunya deteksi dini pada populasi dewasa dengan IMT <23 kg/m2. Skrining pada populasi umum tidak direkomendasikan karena meningkatkan biaya kesehatan.Tujuan. Membuat sistem skoring untuk penapisan lean NAFLD pada populasi dewasa di Jakarta.Metode. Studi ini menggunakan desain potong lintang dari laporan pemeriksaan kesehatan individu dewasa >18 tahun dengan IMT <23 kg/m2 yang melakukan pemeriksaan kesehatan di klinik. Parameter yang dianalisis antara lain usia, jenis kelamin, lingkar pinggang, kadar GDP, kolesterol total, HDL, LDL, trigliserida, AST, ALT, dan asam urat. Variabel dengan nilai p <0,25 dilanjutkan ke analisis multivariat untuk pembuatan sistem skoring.Hasil. Sebanyak 276 individu diikutsertakan pada penelitian ini dan didapatkan prevalensi lean NAFLD sebesar 9,8%. Lean NAFLD lebih banyak ditemukan pada laki-laki dan memiliki karakteristik usia lebih tua, IMT, lingkar pinggang, kadar GDP, ALT, dan trigliserida lebih tinggi dibanding lean tanpa NAFLD. Analisis bivariat mendapatkan jenis kelamin laki-laki, usia ≥45 tahun, kadar GDP ≥100 mg/dL, ALT ≥35 U/L, dan trigliserida ≥150 mg/dL berhubungan dengan lean NAFLD. Sistem skoring melibatkan 4 parameter yaitu laki-laki, kadar GDP ≥100 mg/dL, ALT ≥35 U/L, dan trigliserida ≥150 mg/dL dengan masing-masing bernilai 1 poin. Model skoring ini memiliki sensitivitas 44,4%, spesifisitas 84,3%, dan AUROC 0,74.Kesimpulan. Parameter jenis kelamin, kadar GDP, ALT, dan trigliserida dapat digunakan sebagai sistem skoring dengan performans menengah untuk penapisan lean NAFLD dewasa......Background. Lean NAFLD is commonly found in Asian countries and its prevalence in Indonesia is still unknown. The high prevalence, asymptomatic until complications occur, and the high mortality of lean NAFLD makes it necessary for early detection in adult with BMI <23 kg/m2. Screening in general population is not recommended due to the high cost burden.Aim. To develop a scoring system for screening lean NAFLD in adults in Jakarta Methods. A cross-sectional study design was conducted from medical examination reports from individual >18 years old and BMI <23 kg/m2 who performed medical check up at the clinic. Several parameters including age, gender, waist circumference (WC), fasting blood glucose (FBG), total cholesterol (TC), HDL, LDL, triglycerides (TG), AST, ALT, and uric acid (UA) were analyzed in this study. Variabels with p-value <0.25 were included in multivariate analysis for the development of scoring systems.Results. A total of 276 people were enrolled in this study. Prevalence of lean NAFLD is 9.8%. Lean NAFLD are more commonly found in men and have older age, higher BMI, WC, GDP, ALT, and TG levels than lean non-NAFLD. In bivariate analysis, male sex, age ≥ 45 years, FBG ≥100 mg/dL, ALT ≥35 U/L, and TG ≥150 mg/dL are associated with lean NAFLD. The scoring system involves four parameters including male, FBG ≥100 mg/dL, ALT ≥35 U/L, and TG ≥150 mg/dL, worth 1 point each. This model has sensitivity 44.4%, specificity 84.3%, and AUROC 0.74.Conclusion. Parameters including gender, FBG, ALT, and TG levels can be used as a scoring system with moderate performance for screening lean NAFLD in adults."

"Latar belakang: Indonesia merupakan negara maritim yang berhubungan erat dengan industri pengiriman dan kekayaan laut yang berdampak pada sosio-ekonomik negara. Kesehatan pelaut berperan penting dalam mempertahankan manajemen ini dan perlu mendapat perhatian khusus. Pelaut memiliki risiko mengalami MAFLD, kelelahan saat bertugas, atau kombinasi keduanya. Penelitian ini bertujuan untuk mengetahui hubungan antara MAFLD dengan kelelahan kerja pada Pelaut tugboat.

Metode: Penelitian ini menggunakan metode potong lintang dengan data sekunder hasil MCU karyawan Perusahaan X. MAFLD didefinisikan sebagai fatty liver berdasarkan hasil USG ditambah dengan adanya obesitas atau overweight. Kelelahan diukur menggunakan kuesioner SOFI yang telah divalidasi dalam bahasa Indonesia. Hubungan antara MAFLD dengan kelelahan dianalisis menggunakan uji regresi logistik untuk mendapatkan nilai signifikansi (P), odds ratio (OR) dan interval kepercayaan (IK) 95%.

Hasil: Prevalensi pekerja yang mengalami kelelahan sedang sebanyak 64 orang (23,5%). Kelelahan kerja secara statistik berhubungan signifikan dengan MAFLD (aOR 5,05; IK 95% 2,65-9,60; p <0,001) dan kurangnya aktivitas fisik/olahraga (aOR 2,79; IK 95% 1,17-6,68; p 0,021).

Kesimpulan: Hampir seperempat dari total jumlah pelaut tugboat mengalami kekelahan sedang saat bekerja. Kelelahan tersebut berhubungan signifikan dengan MAFLD dan kurangnya aktivitas fisik/olahraga

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Background: Indonesia is a maritime nation closely associated with shipping industry and oceanic wealth that impacts the country's socio-economic status. The health of sailors plays a crucial role in maintaining this management and requires specific attention. Sailors are at risk of experiencing MAFLD, on-duty fatigue, or a combination of both. This research aims to investigate the relationship between MAFLD and work-related fatigue among tugboat sailors.

Methods: This study used a cross-sectional method with secondary data from the Medical Check-Up (MCU) results of Company X's employees. MAFLD was defined as fatty liver based on ultrasound results combined with the presence of obesity or overweight. Fatigue was measured using the validated SOFI questionnaire in the Indonesian language. The association between MAFLD and fatigue was analyzed using logistic regression to obtain significance values (P), odds ratios (OR), and a 95% confidence interval (CI).

Results: The prevalence of workers experiencing moderate fatigue was 64 individuals (23.5%). Statistically, work-related fatigue was significantly associated with MAFLD (aOR 5.05; 95% CI 2.65-9.60; p <0.001) and insufficient physical activity/exercise (aOR 2.79; 95% CI 1.17-6.68; p 0.021).

Conclusion: Nearly a quarter of the total number of tugboat sailors experience moderate fatigue while working. This fatigue is significantly associated with MAFLD and insufficient physical activity/exercise."

"ABSTRACTBackground: antiretroviral drug-related liver injury (ARLI) is a drug-induced hepatotoxicity due to antiretroviral medication (ARV). It commonly disrupts compliance to treatment and causes treatment discontinuation in HIV-infected patients. Several studies have been conducted on predisposing factors for ARLI including studies on body mass index (BMI) and cluster of differentiation 4 (CD4). The association of BMI and CD4 with ARLI remains controversial as previous studies have demonstrated different outcomes. Our study was conducted to identify the association of low baseline BMI and CD4 cell count as risk factors for ARLI in HIV-infected patients. Methods: this is a cross-sectional study. Subjects were 75 patients with HIV-AIDS who received ARV therapy using fixed-dose combination (tenofovir, lamivudine, efavirenz) at the Teratai HIV outpatient clinic of Hasan Sadikin Hospital in Bandung city. Alanine aminotransferase (ALT) test was performed prior to starting ARV treatment and the test was repeated on the sixth month of therapy. Results: there was no significant difference on the proportion of low baseline CD4 count between ARLI and non-ARLI group (p=0.155). Bivariate analysis demonstrated that regarding the proportion of low baseline BMI, there was a significant difference between ARLI and non-ARLI group (p= 0.001). Multivariate analysis using logistic regression showed that BMI of < 18.5 kg/m2 increased the risk for developing ARLI by 5.53 fold; while CD4 cell count of < 200 cells/µL did not the risk. Conclusion: our study indicates that low baseline BMI may increase the risk for developing ARLI; while low baseline CD4 cell count does not; therefore, we suggest that ALT test should be performed on a routine basis among HIV-AIDS patients for early detection of ARLI, particularly in patients with low BMI."