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"Laporan Kemenkes RI mengenai angka kejadian HIV & AIDS di Indonesia sampai September menyatakan 92.251 kasus HIV dan 39.434 kasus AIDS. ODHA memerlukan ARV untuk menekan replikasi virus. Paduan pengobatan dimulai dari lini pertama yang terdiri atas 2 Nucleoside Reverse Transcriptase Inhibitor (NRTI) dan 1 Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI). Nevirapin adalah ARV golongan NNRTI yang paling sering digunakan karena efektif dan efisien. Evaluasi pengobatan ARV dan data mengenai substitusi ARV masih kurang. Substitusi dapat menggambarkan isu penting berkaitan dengan keberhasilan program pengobatan HIV dan efek samping obat. Desain penelitian ini kasus kontrol dengan data berasal dari rekam medis. Kasus adalah mereka yang mengalami sustitusi nevirapin. Analisis univariat, bivariat dan multivariat logistik regresi dilakukan. Didapatkan faktor-faktor dominan yang berhubungan dengan substitusi nevirapin adalah tingkat pendidikan OR=3,31(CI95%=1,27-8,63) dan kondisi awal terapi yaitu stadium klinis OR=0,37 (CI95%=0,13-1,11), kadar SGOT OR=2,15 (CI95%=0,83-5,57), kadar SGPT dengan OR=1,41 (CI95%=0,61-3,26), dan CD4 dengan OR ==1,80 (CI95%=0,56-5,83). Edukasi kepada pasien dengan tingkat pendidikan rendah mengenai manfaat dan cara minum obat perlu lebih ditekankan dan monitoring keluhan efek samping secara teratur melalui pemeriksaan fisik dan pemeriksaan laborarium secara berkala kepada seluruh penderita HIV/AIDS yang mendapat ARV disertai CD4 dan enzim hati diawal terapi yang tinggi.

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Indonesian Ministry of Health reported that there are 92.251 cases HIV and 39.434 cases AIDS until September 2012. Those people need ARV to suppress viral load dan enhaced their immunity. Based on guideline therapy, starting ARV should from first line which consisted of 2 NRTI (nucleoside reverse transcriptase inhibitor) dan 1 NNRTI (non-nucleoside reverse transcriptase inhibitor). Nevirapin is a NNRTI and more prescribe because its effectiveness and efficiency. In Indonesia, there are less data about antiretroviral evaluation, especially substitution. These data are important to identify some issues such as effectiveness antiretroviral therapy and toxicity. Toxicity that induced by antiretroviral effect nonadherence. This study is using case control design which source of data is medical records. Cases are those who experienced nevirapine substitution. Univariat, bivariat and multivariate logistic regression are using to analyze these data. Result shows that significant factors associated with nevirapine substitution are education level OR=3,31(CI95%=1,27-8,63), clinical staging OR=0,37 (CI95%=0,13-1,11), SGOT level at baseline OR=2,15 (CI95%=0,83-5,57), SGPT level at baseline OR=1,41 (CI95%=0,61-3,26), and CD4 at baseline OR ==1,80 (CI95%=0,56-5,83). This result recommend to educate those who are low education with comprehensive information about antiretroviral and monitoring regularly patients who have elevated level of liver enzime on baseline therapy."

"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)."

"Pada kondisi dengan keterbatasan sumber daya untuk mengakses pemantauan viral load, pemantauan imunologis menjadi bagian dari standar perawatan terapi pasien dengan pengobatan antiretroviral yang dapat digunakan untuk menilai respon terapi. Studi ini dilakukan untuk melihat hubungan antara ketidakpatuhan pengobatan terhadap kegagalan imunologis pada pasien HIV/AIDS di RSPI Prof. Dr. Sulianti Saroso. Studi kohort retrospektif dilakukan di RSPI Prof. Dr. Sulianti Saroso pada 284 pasien HIV/AIDS dewasa yang inisiasi antiretroviral lini pertama pada periode Januari 2014-April 2018, yang diikuti selama 12 bulan waktu pengamatan. Analisis menggunakan Kaplan Meier digunakan untuk mengestimasi probabilitas kegagalan imunologis berdasarkan ketidakpatuhan pengobatan (ambil obat dan minum obat), yang signifikansinya dilihat dengan Log-Rank Test. Analisis Cox Proportional Hazard dilakukan untuk menghitung Hazard Ratio dengan 95% confidence interval. Sebanyak 29 (10,2%) pasien mengalami kegagalan imunologis dengan 4,8 per 10.000 orang hari. Kepatuhan ambil obat (aHR 1,72, 95%CI: 0,67-4,44) dan kepatuhan minum obat (aHR 1,14, 95%CI: 0,41-3,19) berasosiasi terhadap kejadian gagal imunologis, meskipun tidak signifikan. Asosiasi yang tidak signifikan ini dimungkinkan karena pemantauan imunologis bukanlah gold standard dalam menilai respon pengobatan. Perhitungan sensitivitas dan spesifisitas kegagalan imunologis terhadap kegagalan virologis pada penelitian ini yaitu 50% dan 82,66%. Monitoring kepatuhan secara berkala dan pemeriksaan CD4/viral load yang lebih tepat waktu diperlukan untuk mencegah kegagalan pengobatan lebih dini.

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Immunological monitoring becomes standard care of antiretroviral treatment due to the inaccessibility of viral load in a resource-limited setting. The aim of this study was to estimate association between antiretroviral therapy adherence and immunological failure among HIV/AIDS patient in Prof. Dr. Sulianti Saroso Infectious Disease Hospital. Retrospective cohort study was conducted at Prof. Dr. Sulianti Saroso Infectious Disease Hospital on 284 adults who started first-line antiretroviral during period between January 2014 and April 2018, then followed for about 12 months. Kaplan Meier was used to estimate probability of immunological failure based on pharmacy refill adherence and self report adherence, and their significance assessed using Log Rank Test. Cox Proportional Hazard model was fitted to measured Hazard Ratio with their 95% confidence interval. 29 (10,2%) patient has developed immunological failure with hazard rate of 4,8 per 10.000 person-day of follow up. Pharmacy refill adherence (aHR 1,72, 95%CI: 0,67-4,44) and self report adherence (aHR 1,14, 95%CI: 0,41-3,19) were associated with immunological failure. The association was not significant may because of immunological failure is not the gold standard to evaluate therapy response. Calculation of the sensitivity and specificity between immunological failure and virological failure for about 50% and 83%. Routine adherence monitoring and CD4 or viral load laboratorium measuring on schedule need to early prevent therapy failure."

"Bunuh diri merupakan kegawatdaruratan psikiatri yang lazim ditemukan pada pasien HIV/AIDS dan dihubungkan dengan berbagai faktor. Namun, studi ini belum pernah dilakukan di Indonesia, padahal studi ini penting untuk diteliti untuk menentukan faktor-faktor yang harus diintervensi sehingga terbentuk pelayanan yang optimal terhadap pasien HIV. Penelitian ini bertujuan untuk mengetahui hubungan antara ide bunuh diri dengan faktor-faktor yang memengaruhinya pada pasien HIV/AIDS. Metode penelitian adalah dengan cross-sectional. Subjek dikumpulkan sebagai sampel menggunakan teknik consecutive sampling. Kriteria inklusi adalah orang dewasa berusia 18-65 tahun dengan diagnosis HIV/AIDS yang sedang menjalani pengobatan ARV di Poliklinik Khusus HIV/AIDS RSCM. Analisis data bivariat menggunakan uji Chi-square dan Fisher exact test, serta analisis multivariat menggunakan uji regresi logistik. Dari total 86 subjek, 20 23,3 diantaranya memiliki ide bunuh diri. Melalui uji Chi-square, hubungan terbukti bermakna pada 5 variabel, yaitu depresi p=0,000, ansietas p=0,001, tidak menikah p=0,007, jumlah CD4.

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Suicide is a psychiatric emergency commonly found in HIV AIDS patients and is associated with various factors. However, this study has not been conducted in Indonesia. Besides, this study is important to determine the factors which must be intervened to establish optimum service for HIV AIDS patients. The aim of this study is to find the association between suicidal ideation and its determinant factors in HIV AIDS patients. Observational study with cross sectional method was conducted. Samples were collected using consecutive sampling technique. The inclusion criteria were adults aged 18 65 with HIV AIDS diagnosis and currently undergoing ARV treatment at Poliklinik Khusus HIV AIDS RSCM. Univariate analysis was performed using Chi square and Fisher exact test, while multivariate analysis was performed using logistic regression test. Of the total 86 subjects, 20 23.3 had suicidal ideation. Chi square test proved significant association on 5 variables depression p 0,000, anxiety p 0,001, being unmarried p 0,007, CD4 count."

"ABSTRAK Latar Belakang: Hingga saat ini belum ada panduan mengenai paduan terapiantiretroviral (antiretroviral therapy/ART) terpilih pada pasien HIV dewasadengan riwayat interupsi tidak terencana. Kondisi pasien pada saat reintroduksiART perlu dievaluasi sebagai dasar pemilihan paduan ART Tujuan: Mengetahui proporsi keberhasilan virologis pada reintroduksi ART linipertama pasca interupsi tidak terencana. Mengetahui hubungan antara berbagaifaktor klinis dan laboratoris dengan keberhasilan virologis pada reintroduksi tersebut. Metode: Penelitian kohort retrospektif dilakukan pada pasien HIV yangmendapatkan reintroduksi ART lini pertama pasca interupsi tidak terencanaselama minimal 1 bulan. Data didapatkan dari rekam medis RS dr. CiptoMangunkusumo di Jakarta. Viral load (VL) dinilai 6-18 bulan setelah reintroduksiART lini pertama, dinyatakan berhasil bila VL <400 kopi/ml. Dilakukan analisisterhadap faktor yang berhubungan dengan keberhasilan virologis tersebut.Hasil: Selama periode Januari 2005 s.d. Desember 2014 terdapat 100 subjek yangmendapatkan reintroduksi ART lini pertama dan memiliki data viral load 6-18bulan pasca reintroduksi. Pasca reintroduksi ART didapatkan keberhasilanvirologis pada 55 (55%) subjek. Pada analisis didapatkan dua faktor yangberhubungan dengan keberhasilan virologis pada reintroduksi ART lini pertama,yaitu frekuensi interupsi satu kali (adjusted OR/aOR 5,51; IK95% 1,82-16,68;p=0,003), nilai CD4 saat reintroduksi ≥200 sel/mmxi 3 (aOR 4,33; IK95% 1,1416,39,p=0,031).Simpulan:Proporsi keberhasilan virologis pada reintroduksi ART lini pertamapasca interupsi tidak terencana adalah 55%. Pasien dengan frekuensi interupsi 1kali dan pasien dengan nilai CD4 saat reintroduksi ≥200 sel/mm3 memiliki kecenderungan untuk mencapai keberhasilan virologis pada reintroduksi ART.ABSTRACT There is no guideline concerning antiretroviral therapy (ART) ofchoice for adult HIV patients after unplanned interruption. Hence, patients?conditions at time of ART reintroduction need to be evaluated as a basis forselecting ART regiment. Objectives: To know the proportion of virological success of first line ARTreintroduction after unplanned interruption. To know the association betweeneither clinical or laboratory factors and virological success in reintroduction. Methods: We conducted a retrospective cohort study in HIV patients that werereintroduced to first line ART after having unplanned interruption for at least onemonth period. The data were collected from medical records of Dr. CiptoMangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18months after first line ART reintroduction, declared as a success if VL <400copies/mL. Analysis was done to factors associated with such virological success.Results: Between January 2005 and December 2014, 100 subjects werereintroduced to first line ART and having VL data in 6 to 18 months after thereintroduction. Virological success was achieved in 55 (55%) subjects. In theanalysis we found that virological success was associated with interrupted once(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mmxii Universitas Indonesia 3at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).Conclusions: Proportion of virological success on first line ART reintroductionafter unplanned interruption was 55%. Patients who were having interrupted onceand patients with CD4 ≥200 cell/mm3 at the time of reintroduction would havehigher odds of virological success on first line ART reintroduction.;Background: There is no guideline concerning antiretroviral therapy (ART) ofchoice for adult HIV patients after unplanned interruption. Hence, patients?conditions at time of ART reintroduction need to be evaluated as a basis forselecting ART regiment. Objectives: To know the proportion of virological success of first line ARTreintroduction after unplanned interruption. To know the association betweeneither clinical or laboratory factors and virological success in reintroduction. Methods: We conducted a retrospective cohort study in HIV patients that werereintroduced to first line ART after having unplanned interruption for at least onemonth period. The data were collected from medical records of Dr. CiptoMangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18months after first line ART reintroduction, declared as a success if VL <400copies/mL. Analysis was done to factors associated with such virological success.Results: Between January 2005 and December 2014, 100 subjects werereintroduced to first line ART and having VL data in 6 to 18 months after thereintroduction. Virological success was achieved in 55 (55%) subjects. In theanalysis we found that virological success was associated with interrupted once(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mmxii Universitas Indonesia 3at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).Conclusions: Proportion of virological success on first line ART reintroductionafter unplanned interruption was 55%. Patients who were having interrupted onceand patients with CD4 ≥200 cell/mm3 at the time of reintroduction would havehigher odds of virological success on first line ART reintroduction.;Background: There is no guideline concerning antiretroviral therapy (ART) ofchoice for adult HIV patients after unplanned interruption. Hence, patients?conditions at time of ART reintroduction need to be evaluated as a basis forselecting ART regiment. Objectives: To know the proportion of virological success of first line ARTreintroduction after unplanned interruption. To know the association betweeneither clinical or laboratory factors and virological success in reintroduction. Methods: We conducted a retrospective cohort study in HIV patients that werereintroduced to first line ART after having unplanned interruption for at least onemonth period. The data were collected from medical records of Dr. CiptoMangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18months after first line ART reintroduction, declared as a success if VL <400copies/mL. Analysis was done to factors associated with such virological success.Results: Between January 2005 and December 2014, 100 subjects werereintroduced to first line ART and having VL data in 6 to 18 months after thereintroduction. Virological success was achieved in 55 (55%) subjects. In theanalysis we found that virological success was associated with interrupted once(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mmxii Universitas Indonesia 3at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).Conclusions: Proportion of virological success on first line ART reintroductionafter unplanned interruption was 55%. Patients who were having interrupted onceand patients with CD4 ≥200 cell/mm3 at the time of reintroduction would havehigher odds of virological success on first line ART reintroduction.;Background: There is no guideline concerning antiretroviral therapy (ART) ofchoice for adult HIV patients after unplanned interruption. Hence, patients?conditions at time of ART reintroduction need to be evaluated as a basis forselecting ART regiment. Objectives: To know the proportion of virological success of first line ARTreintroduction after unplanned interruption. To know the association betweeneither clinical or laboratory factors and virological success in reintroduction. Methods: We conducted a retrospective cohort study in HIV patients that werereintroduced to first line ART after having unplanned interruption for at least onemonth period. The data were collected from medical records of Dr. CiptoMangunkusumo Hospital in Jakarta. Viral load (VL) was evaluated at 6-18months after first line ART reintroduction, declared as a success if VL <400copies/mL. Analysis was done to factors associated with such virological success.Results: Between January 2005 and December 2014, 100 subjects werereintroduced to first line ART and having VL data in 6 to 18 months after thereintroduction. Virological success was achieved in 55 (55%) subjects. In theanalysis we found that virological success was associated with interrupted once(adjusted OR/aOR 5.51%, 95%CI 1.82-16.68, p=0.003) and CD4 ≥200 cell/mmxii Universitas Indonesia 3at the time of reintroduction (aOR 4.33, 95%CI 1.14-16.39, p=0.031).Conclusions: Proportion of virological success on first line ART reintroductionafter unplanned interruption was 55%. Patients who were having interrupted onceand patients with CD4 ≥200 cell/mm3 at the time of reintroduction would havehigher odds of virological success on first line ART reintroduction."

"Latar Belakang: Pada ODHA didapatkan peningkatan inflamasi dan stres oksidatif. Puasa Ramadan dapat memperbaiki inflamasi dan stres oksidatif, namun penelitian pada ODHA yang mendapat antiretroviral belum pernah dilakukan. Tujuan: Mengetahui pengaruh puasa Ramadan terhadap high sensitivity Creactive protein (hs-CRP) dan status antioksidan total (SAT) pada ODHA yang mengonsumsi antiretroviral. Metode: Penelitian ini merupakan penelitian prospektif pada 29 orang ODHA dengan ARV yang berpuasa dan 29 yang tidak berpuasa. Kriteria inklusi yaitu pria, 20-40 tahun, mendapat ARV lini 1 minimal 6 bulan, serta tidak dalam fase inisiasi pengobatan untuk infeksi oportunistik. Pasien yang mendapat steroid atau imunosupresan lain atau pasien dengan adherens minum ARV kurang dari 95% dieksklusi. Pemeriksaan kadar hs-CRP dan SAT dilakukan sebelum dan saat puasa Ramadan (setelah 14 hari puasa). Hasil: Karakteristik baseline usia, hitung CD4, HIV-RNA, kombinasi ARV, status hepatitis B dan C, serta kadar hs-CRP tidak berbeda antara kelompok berpuasa dengan kontrol. Setelah dua minggu, terdapat penurunan signifikan hs-CRP pada kelompok yang berpuasa dibandingkan kontrol (p=0,004). Median perubahan hs-CRP pada kelompok puasa adalah -0,41 (IQR -1; 0,1) mg/L, sedangkan pada kelompok kontrol adalah 0,2 (IQR -0,3; 1,5) mg/L. Konsumsi polyunsaturated fatty acid, berat badan, jumlah rokok, dan jumlah jam tidur per hari menurun selama puasa Ramadan (berturut-turut p=0,029; p<0,001; p<0,001; dan p<0,001). Tidak ditemukan perbedaan bermakna perubahan SAT antara kelompok yang berpuasa dengan kontrol (p=0,405). Median perubahan SAT pada kelompok puasa adalah 0,05 (IQR -0,03; 0,12) mmol/L, sedangkan pada kelompok kontrol adalah 0,04 (IQR -0,13; 0,36) mmol/L. Simpulan: Puasa Ramadan menurunkan kadar hs-CRP pada ODHA yang mengosumsi antiretroviral. Puasa Ramadan belum meningkatkan kadar SAT pada ODHA yang mengonsumsi antiretroviral.

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Background: Inflamation and oxidative stress were increased among HIV patients. Studies had showed Ramadan fasting could improve inflammation and oxidative stress, but not one of them had been conducted in HIV patients receiving antiretroviral therapy.

Aim: to know the effect of Ramadan fasting on hs-CRP level and total antioxidant status among HIV patients on highly active antiretroviral therapy.

Methods: A prospective cohort study comparing 29 HIV-infected patients on stable ART doing Ramadan fasting versus 29 non-fasting patients. Inclusion criteria were male, 20-40 years old, receiving first line ART for at least six months, and not on initial phase of opportunistic infection?s treatment. Patients who consumed steroid or other immunosuppressant or patients with poor ART adherence were excluded. Level of hs-CRP was obtained before and during Ramadan after at least 14 days fasting.

Results: Baseline age, CD4 cell count, HIV-RNA, ART combination, hepatitis B and hepatitis C status, and hs-CRP level were similar for both fasting and control groups. After 2 weeks, a significant hs-CRP decrease was found in fasting group compared to non-fasting one (p=0.004). Median difference of hs-CRP in fasting group was -0.41 (IQR -1 and 0.1) mg/L, while in control group the median difference was 0.2 (IQR -0.3 and 1.5) mg/L. Polyunsaturated fatty acid consumption, body weight, amount of cigarette smoking, and total sleep hours per day were decreased significantly during Ramadan fasting (p=0.029; p<0.001, p<0.001, p<0.001 respectively). There was no statistically significant changes in total antioxidant status between the two groups (p=0.405). Median total antioxidant status changes in fasting group was 0.05 (IQR -0.03;0.12) mmol/L. Median total antioxidant status changes in control group was 0.04 (IQR -0.13; 0.36) mmol/L.

Conclusion: Ramadan fasting decreased hs-CRP level among HIV patients on antiretroviral therapy. Ramadan fasting had not increased total antioxidant status among HIV patients on antiretroviral therapy."

"Infeksi HIV dan penyakit AIDS saat ini telah menjadi masalah kesehatan global. Sejak awal abad ke 21 peningkatan jumlah kasus semakin mencemaskan di Indonesia. Penyebaran infeksi HIV biasanya terjadi pada perilaku seksual, tetapi beberapa tahun belakangan ini resiko penularan lebih banyak terjadi pada pengguna narkoba suntik.Penelitian ini menggunakan desain studi kohort retrospektif dengan 164 sampel dan dilakukan selama juli-september 2012 yang bertujuan untuk mengetahui hubungan antara cara penularan terhadap ketahanan hidup 9 tahun pasien HIV/AIDS di RS Kanker Dharmais Jakarta Tahun 2003-2011 setelah dikontrol oleh variabel lain, dengan faktor confounding yaitu jumlah CD4, infeksi oportunistik, jenis kelamin, usia, status pernikahan, jenis pekerjaan, tingkat pendidikan dan daerah tempat tinggal. Data penelitian diperoleh melalui data rekam medis RS. Data dianalisis dengan menggunakan analisis survival metode kaplan meier dan dilanjutkan dengan analisis multivariat.Hasil penelitian menunjukkan bahwa probabilitas kumulatif ketahanan hidup secara umum pada pasien HIV/AIDS cukup baik. Terdapat hubungan yang signifikan antara kadar CD4 terhadap ketahanan hidup (nilai p=0,03) dan infeksi oportunistik terhadap ketahanan hidup (nilai p=0,00. Faktor infeksi oportunistik dan jumlah CD4 memiliki hubungan dengan cara penularan untuk mempengaruhi ketahanan hidup 9 tahun pasien HIV/AIDS dan terbukti sebagai faktor confounding. Sedangkan faktor counfounding lain tidak menunjukkan adanya hubungan terhadap ketahanan hidup 9 tahun pasien HIV/AIDS.Hal yang disarankan adalah menekankan penatalaksanaan yang lebih intensif terhadap pencegahan infeksi oportunistik pada pasien yang sudah positif HIV.

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HIV and AIDS infection has been a pandemic health problem. Since the beginning of 21 century, case increasing in Indonesia has so disquiet. Infection transmission of HIV commonly happen to sexual activity, but the risk of transmission in drug user become more increase recently years.

This research use cohort retrospective design with 164 samples as long july until novemver 2012 which have purpose for knowing the relationship between transmission way to 9 years survival of HIV/AIDS patient at Dharmais Cancer Hospital, Jakarta 2003-2011 after adjustment with other variables. And also will discuss about CD4, opportunistic infection, other treatment history, sex, age, marriage state, type of occupations, education level, and domicile. Research data get from hospital medical record. Analized data use Kaplan meier survival analysis until multivariate test.

Research result show that survival cumulative probability of HIV/AIDS patients in generally is good. And also, there is a significant relation between CD4 to survival (Pvalue =0.03) and opportunistic infection to survival (Pvalue = 0.001). Opportunistic infection and CD4 proved as confounding factor between transmission way to survival. While, the other confounding factors haven’t significant relationship to 9 years survival of HIV/AIDS patients.

Recommended suggestion is to accentuating management for opportunistic infection prevention."

"[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.]"