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Dolly Dolven Kansera
Insidens dan Faktor Prediktor Sindrom Pulih Imun TB Pada Pasien HIV Dewasa Dalam Terapi Antiretroviral Lini Pertama = Incidence and Predictors for Immune Reconstitution Inflammatory Syndrome in Adult HIV Patient on First Line Antiretroviral Therapy
"Latar Belakang. Sindrom pulih imun (SPI) TB adalah fenomena yang sudah dikenal luas yang dapat menyulitkan terapi antiretroviral. Saat ini belum ada penelitian mengenai insidens dan faktor prediktor terhadap terjadinya SPI TB di Indonesia. Dengan mengetahui insidens dan faktor prediktor yang berperan diharapkan dapat membantu klinisi mengidentifikasi terjadinya SPI TB dan merencanakan tindakan pencegahan dan penatalaksanaan.
Tujuan. Mengetahui insidens, kesintasan, dan faktor-faktor prediktor terjadinya SPI TB pada pasien HIV dewasa yang dalam terapi ARV lini pertama.
Metode. Penelitian kohort retrospektif terhadap 1344 pasien yang mendapat terapi antiretroviral untuk pertama kali di RSCM pada kurun waktu Januari 2007 - Desember 2011. Faktor prediktor yang diteliti adalah indeks massa tubuh (IMT) saat memulai ARV, jumlah CD4+ baseline, perubahan jumlah CD4+ setelah ARV (pada kedua jenis SPI), interval pemberian OAT dan ARV dan terdapatnya TB ekstraparu atau diseminata (pada yang paradoksikal). Analisis Cox Proportional Hazard Model dilakukan untuk mendapatkan adjusted Hazard Ratio (HR) prediktor yang diteliti.
Hasil. Insidens kumulatif SPI TB paradoksikal adalah 11,73 % dengan incidence density 0,59 per 100 pasien-minggu, kesintasan kumulatif 87,1 % (SE 1,8 %), serta rerata kesintasan 22,14 minggu (interval kepercayaan [IK] 95% 21,56-22,70). Insidens kumulatif SPI TB unmasking adalah 3,05 % dengan incidence density 0,29 per 100 pasien-minggu, kesintasan kumulatif 96,6 % (SE 0,6 %), serta rerata kesintasan 11,82 minggu (interval kepercayaan [IK] 95% 11,74-11,90). IMT (adjusted HR 4,141; IK 95% 2,318 – 7,397) dan TB ekstra paru (adjusted HR 4,659; IK 95% 2,556 – 8,489) adalah faktor prediktor yang bermakna terhadap terjadinya SPI TB paradoksikal, sedangkan IMT (adjusted HR 2,755; IK 95% 1,214 – 6,254) menjadi satu-satunya faktor prediktor yang bermakna pada SPI TB unmasking.
Kesimpulan : Insidens kumulatif SPI TB paradoksikal adalah 11,73 %, sedangkan insidens kumulatif SPI TB unmasking adalah 3,05 %. IMT dan TB ekstra paru adalah faktor prediktor yang bermakna terhadap terjadinya SPI TB paradoksikal, sedangkan IMT menjadi satu-satunya faktor prediktor yang bermakna pada SPI TB unmasking.
Background. Immune Reconstitution Inflammatory Syndrome (IRIS) TB is a widely-known phenomenon complicating antiretroviral therapy. There have been no research about incidence of IRIS TB in Indonesia and about predictors of IRIS TB. Determination of incidence and predictors of IRIS TB is expected to help clinicians to identify IRIS TB event earlier in order to manage the patient better and to prevent the event.
Objective. The objective of this research was to determine the incidence, survival, and predictors of IRIS TB event in adult HIV patient on first line antiretroviral therapy.
Method. Retrospective cohort was performed to 1344 patients (392 patients have been diagnosed with TB and 952 patients have not) who received antiretroviral therapy for the first time in RSCM Hospital between January 2007 – December 2011.
The predictors analyzed in this research were body mass index (BMI), baseline CD4+, changes of CD4+ after ARV therapy (in both type of IRIS TB), time interval between anti tuberculosis and antiretroviral therapy initiation, and the presence of extrapulmonary or disseminated TB (in paradoxical IRIS TB). Cox Proportional Hazard Model analysis was performed to get adjusted Hazard ratio (HR) of the observed predictors.
Result. Cumulative incidence of paradoxical IRIS TB was 11,73 % with incidence density 0,59 per 100 patient-week, cumulative survival 87,1 % (SE 1,8 %), and mean survival 22,14 weeks (CI 95% 21,56-22,70). Meanwhile, cumulative incidence of unmasking IRIS TB was 3,05 % with incidence density 0,29 per 100 patient-week, cumulative survival 96,6 % (SE 0,6 %), and mean survival 11,82 weeks (CI 95% 11,74-11,90).
BMI (adjusted HR 4,141; CI 95% 2,318 – 7,397) and extrapulmonary TB (adjusted HR 4,659; CI 95% 2,556 – 8,489) were predictors for paradoxical IRIS TB, while BMI (adjusted HR 2,755; CI 95% 1,214 – 6,254) was the only predictor for unmasking IRIS TB.
Conclusion: Cumulative incidence of paradoxical IRIS TB was 11,73 % with cumulative survival 87,1 % and mean survival 22,14 weeks. Meanwhile, Cumulative incidence of unmasking IRIS TB was 3,05 % with cumulative survival 96,6 % and mean survival 11,82 weeks. BMI and extrapulmonary TB were predictors for paradoxical IRIS TB, while BMI was the only predictor for unmasking IRIS TB."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
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Ndaru Andri Damayanti
Regulasi respons imun subyek di permukiman kumuh : studi imunitas seluler pada kultur sel darah yang distimulasi malaria, vaksin BCG dan LDL = Regulation of immune respons to people living in the slum area a study of celluler immunity on whole blood cultures stimulated malaria BCGb and LDL
"Introduction: Constant exposure to a variety of microorganisms in domestic environment plays an important role in the shaping of individual immune response mechanism, which can affect one's susceptibility to the diseases. The aim of the study to get an understanding how the exposure of microorganisms in the the different area where the people living might give a contribution to the profile and the regulation of the immune respons after stimulated to malaria, vaccine BCG and oxLDL antigents in PBMC and whole blood cultures, and to evaluate the character of T reg as a mediator to suppress the cell proliferation.
Methode: It is an in vitro experimental study performed at Laboratorium Terpadu, Faculty of Medicine Univertas Indonesia, Jakarta in 2013 2014. As a model of infectious diseases is used pathogenic antigents such as Plasmodium falciparum infected red blood cells malaria and bacille calmette gu rin BCG vaccine, and as a modell of inflammatory disease is used non a patonegic antigen, low density lipoprotein LDL . Whole blood cultures is done for 80 blood samples to know how the regulation of immune respons from people living a rural populatin. PBMC cultures is also done to explore macrophages after stimulated to malaria, BCG and LDL. PHA stimulated to the PBMC culture with and without T reg cells to evaluate the character of T reg. T regulatory cells perhaps play the important roles to suppress the immune respons to microorganisms was also done.
Results: The profile of the immune respons of the people living in the unslum area is significantly more inflamatif than that in the slum area. The ratio of pro anti inflammation cytokines TNF IL 10 of the people living in the unslum area is significantly higher than that in the slum area. This is marked by increasing of oxLDL accumulationis that is the important point of the low protection to oxLDL of the people living in the unslum area p 0.01 . T regulatory cell may suppress the proliferation in the PBMC culture for the people living in the slum area marked by increasing not only the expression of IL 10 cytokines but also the sum of T regulatory sells p 0.01 significantly.
Conclusion: The immune respons of the people living in the unslum area is more inflamatif and responsive to malaria, BCG vaccine and oxLDL. The character of macrophage of the people living in the slum area is marked by the low ratio of pro anti inflammation cytokines TNF IL 10 to malaria, BCG vaccine and oxLDLstimulations. T regulatory cell may suppress the proliferation in the PBMC culture for the people living in the slum."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
D-Pdf
UI - Disertasi Membership  Universitas Indonesia Library
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A. Guntur Hermawan
The role of immune response in immunocompromised conditions
"A patient is said to be immuno-compromised (1C) if one or more of his or her natural and adaptive defense mechanisms are unable to function normally. Thus, immuno-compromised patients are easily susceptible to infection. Aim of study; to determine the immune response in immuno-compromised patients that makes them easily susceptible to infection. Method: the study was designed as a cross-sectional analytic observational study using multi-variant statistical tests. The samples were classified into the 1C and Non-iC groups, consisting of 14 people, 10 men, and 4 women, who were examined far the following immunologi-cal variables: IL-10, IFN-y, TNF-a, IL-I& IgG, C3, and C4. The results demonstrated a significant difference in the immune response of subjects from the 1C and NIC groups (p<0.05), with a significantly higher TNF-Ct, IL-10 and IgG levels, and a lower C3 level in the 1C group. Conclusion: during 1C conditions, there is a disorder in the natural as well as adaptive C3 natural immune system, making patients more susceptible to infection."
2002
AMIN-XXXIV-3-JuliSep2002-102
Artikel Jurnal  Universitas Indonesia Library
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Bertin Tanggap Tirtana
Tren peningkatan rerata berat badan dan faktor-faktor yang berpengaruh pada pasien HIV/AIDS yang mendapat inisiasi antiretroviral lini pertama pada tiga tahun awal pengobatan = Trend of increase in average body weight and factors affecting HIV/AIDS patients who received first-line antiretroviral initiation in the initial three years of treatment
"Latar Belakang. Studi-studi menunjukkan ditemukannya kekhawatiran baru komplikasi metabolik akibat Peningkatan rerata berat badan yang timbul selama pemberian terapi kombinasi ARV. Peningkatan rerata berat badan ini menyebabkan terjadinya overweight dan obesitas yang mengancam terjadinya peningkatan morbiditas dan mortalitas pada pasien HIV. Peningkatan rerata berat badan dan faktor determinannya pada berbagai penelitian masih menunjukkan hasil yang inkonklusif pada tiap populasi.
Tujuan. Penelitian ini bertujuan untuk mengetahui adanya Peningkatan rerata berat badan dan faktor-faktor yang berpengaruh pada pasien HIV/AIDS yang mendapat inisiasi antiretroviral lini pertama pada tiga tahun awal pengobatan.
Metode. Penelitian ini dilakukan dengan desain kohort retrospektif pada pasien HIV yang memulai inisiasi ARV di RSUPN Dr. Cipto Mangunkusumo tahun 2017-2020. Subjek dikumpulkan berdasarkan metode total sampling. Variabel bebas yang diteliti meliputi jenis kelamin, usia, jumlah CD4+awal, IMT awal, stadium klinis WHO, komorbid infeksi TB, regimen ARV inisiasi lini pertama, dan kepatuhan berobat. Variabel terikat yang diteliti adalah Peningkatan rerata berat badan. Analisis multivariat dilakukan dengan metode Linear Mixed Model terhadap variabel bebas dengan nilai p<0,25 pada uji bivariat. Kurva grafik rerata berat badan ditampilkan untuk menggambarkan Peningkatan rerata berat badan.
Hasil. Sebanyak 734 data subjek penelitian diolah dalam proses analisis data. Peningkatan rerata berat badan paling cepat terlihat pada 6 bulan pertama pemberian ARV, yaitu sebesar 3,66 kg ± 5,85. Rerata berat badan pasien HIV sebelum terapi ARV adalah 57,7 kg, rerata berat badan pasien HIV yang mendapat ARV pada bulan ke 6 adalah 62,1 kg, pada bulan ke 12 menjadi 63,5 kg. Pada bulan ke 24, rerata berat badan pasien HIV yang mendapat ARV adalah 66 kg dan menjadi 66,9 kg pada bulan ke 36. Faktor determinan yang berpengaruh terhadap peningkatan rerata berat badan adalah jenis kelamin laki-laki (Beta 7,79, IK 95% 6,598-8,961), usia< 50 tahun (Beta 1,55, IK 95% 0,046-3,049), jumlah CD4+≤200 sel/mm3 (Beta 2,15, IK 95% 0,98-3,32), kepatuhan berobat (Beta 1,98, IK 95% 0,40 - 3,55), IMT awal (Beta 2,54, IK 95% 2,406-2,685),stadium klinis WHO III (Beta 2,14, IK 95% 0,131-4,149) dan adanya komorbid infeksi TB (Beta -5,75, IK 95% -6,11 -(-5,39))
Simpulan. Pemberian ARV dalam 3 tahun pertama meningkatkan rerata berat badan pasien HIV/AIDS. Peningkatan rerata berat badan ini dipengaruhi oleh jenis kelamin, usia, jumlah CD4+ awal, kepatuhan berobat, IMT awal, stadium klinis WHO dan adanya komorbid infeksi TB.
Background. Studies have raised new concerns about metabolic complications due to the increase in mean body weight during combination ARV therapy. This increase in average body weight causes overweight and obesity, which threatens to increase morbidity and mortality in HIV patients. The increase in average body weight and its determinants in various studies still shows inconclusive results in each population.
Objective. This study aims to determine the average increase in body weight and the factors influencing HIV/AIDS patients who received first-line antiretroviral initiation in the first three years of treatment.
Method. This study was conducted with a retrospective cohort design in HIV patients who initiated ARV at Dr. Cipto Mangunkusumo in 2017-2020. Subjects were collected based on the total sampling method. The independent variables studied included gender, age, initial CD4+ count, initial BMI, WHO clinical stage, comorbid TB infection, first- line initiation of ARV regimen, and medication adherence. The dependent variable studied was the increase in the average body weight. Multivariate analysis was performed using the Linear Mixed Model method on the independent variables with a p-value of <0.25 in the bivariate test. The average body weight graph curve illustrates the increase in the average weight.
Results. A total of 734 research subject data was processed in the data analysis process. The fastest increase in average body weight was seen in the first six months of ARV administration, which was 3.66 kg ± 5.85. The average body weight of HIV patients before ARV therapy was 57.7 kg; the average weight of HIV patients who received ARVs at the 6th month was 62.1 kg; at the 12th month, it became 63.5 kg. At month 24, the mean weight of HIV patients receiving ARV was 66 kg and became 66.9 kg at month 36. The determinant factors that affect the increase in average body weight are male gender (Beta 7.79, 95% CI 6.598-8.961), age below 50 years (Beta 1.55, 95% CI 0.046-3.049), CD4+ count lower than 200 cells/mm3 (Beta 2.15, 95% CI 0.98-3.32), medication adherence (Beta 1.98, 95% CI 0.40 - 3.55), initial BMI (Beta 2.54, 95% CI 2.406-2.685), WHO III clinical stage (Beta 2.14, 95% CI 0.131-4.149) and presence of comorbid TB infection (Beta -5.75, 95% CI -6.11 -(-5.39) )).
Conclusion. Giving ARV in the first three years increases the average body weight of HIV/AIDS patients. The increase in average body weight was influenced by gender, age, initial CD4+ count, medication adherence, initial BMI, WHO clinical stage, and the presence of comorbid TB infection."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Mak, Tak W.
Primer to the immune response : academic cell update
Amsterdam: Elsevier, 2011
616.079 MAK p
Buku Teks  Universitas Indonesia Library
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Nurul Wandasari Singgih
Analisis ketahanan hidup 9 tahun pasien HIV/AIDS yang mendapat terapi Antiretroviral (ARV) berdasarkan cara penularan di RS Kanker Dharmais Jakarta : analisis data rekam medis RS Kanker Dharmais Jakarta tahun 2003-2011 = Survival analysis of 9 years HIV/AIDS patients who get Antiretroviral therapy based on transmission way at Dharmais Cancer Hospital Jakarta : medical record analysis 2003-2011
"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.
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."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2013
T33171
UI - Tesis Membership  Universitas Indonesia Library
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Farid Kurniawan
Faktor prediktor awal kegagalan virologis pada pasien dengan infeksi human immunodeficiency virus yang mendapat terapi antiretroviral lini pertama dengan adherens baik = Early predictive factor of virological failure in hiv patients receiving first line antiretroviral therapy with good adherence
"[ABSTRAK
Latar 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.
ABSTRACT
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 Indonesia
Methods: 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 Indonesia
Methods: 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 Indonesia
Methods: 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.]"
2015
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Evy Yunihastuti
Telaah profil imunologi dan prediktor sindrom pulih imun hepatitis C pada pasien konfeksi HIV dan HCV yang memulai terapi antiretroviral kombinasi
Depok: Universitas Indonesia, 2010
D1760
UI - Disertasi Open  Universitas Indonesia Library
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Yani Kurniawan
Pemeriksaan TNFα dan IL-10 untuk Menilai Kerentanan Imun dengan Immune Status Quesionaire pada Orang Dewasa dengan Kelebihan Berat Badan = Assessment of TNFα and IL-10 to evaluate immune susceptibility with Immune Status Quesionaire in overweight adult subjects
"Pada beberapa tahun ini, peningkatan keparahan penyakit kronis dan gangguan kualitas hidup berhubungan dengan kondisi overweight pada orang dewasa dan termasuk dalam chronic low grade Inflamation. Penelitan terhadap kondisi overweight pada orang dewasa dilihat dari sisi imunitas tergambarkan pada beberapa mediator sel imun khususnya sitokin dalam hal ini TNF-α, IL-6 dan IL-10. Sitokin inflamasi pada individu overweight diproduksi berlebih oleh white adipose tissue sehingga terjadi ketidakseimbangan dalam imunitas. Kuesioner Status imun dapat menilai kerentanan seseorang terhadap penyakit yang berhubungan dengan imunitas. Melalui penelitian ini bertujuan menganalisis hubungan mediator inflamasi: TNF-α/IL-10 dengan skor status Imunitas menggunakan kuesioner yang tervalidasi dan membandingkan sitokin tersebut antara kelompok golongan non- dan Overweight -Obesitas. Penelitian ini menggunakan studi potong lintang dengan data kuesioner pada 100 subjek yang diukur serum darah TNFα, IL-10 menggunakan teknik magnetic luminex multiplex immunoassay. Hasil analisa didapatkan perbedaan bermakna antara nilai TNFα di kelompok non- dengan nilai TNFα pada kelompok obese-overweight dengan p= 0.028 (p<0.05) dan pada rasio sitokin tersebut dengan p= 0.032(p<0.05). Hubungan skor ISQ dengan TNFa korelasi p=0.039 (p<0.05). Dapat disimpulkan adanya hubungan bermakna antara TNFα berikut rasionya dengan skor ISQ serta ditemukan kadar TNFα dan rasionya pada kelompok overweigth-obese lebih tinggi dibandingkan dengan kelompok non Overweight -Obesitas
In recent years, increased severity of chronic disease and impaired quality of life have been associated with overweight in adults and as part chronic low grade inflammation. Research on overweight conditions in adults in terms of immunity is described in several immune cell mediators, especially cytokines in this case TNF-α, IL-6 and IL-10. Inflammatory cytokines in overweight individuals are produced in excess by white adipose tissue, resulting in an imbalance in immunity. The Immune Status Questionnaire can assess a person's susceptibility to immune-related diseases. This study aims to analyze the relationship between inflammatory mediators: TNF-α/IL-10 with Immunity status scores using a validated questionnaire and compare these cytokines between the non- and Overweight-Obesity groups. This study was cross-sectional study with questionnaire data on 100 subjects and blood serum TNFα, IL-10 were measured using magnetic luminex multiplex immunoassay technique. The results of the analysis showed a significant difference between the TNFα in the non-group and the TNFα in the obese-overweight group with p= 0.028 (p<0.05) and the ratio with p= 0.032 (p<0.05). The relationship between ISQ scores and TNFa correlation p=0.039 (p<0.05). It concluded that there is a significant relationship between TNFα and its ratio with ISQ scores and found TNFα levels and ratios in the overweight-obese group were higher than in the non-Overweight-Obesity group"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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Nancy Dian Anggraeni
Ketahanan hidup satu tahun pasien HIV/AIDS dengan pengobatan Regimen ARV Lini pertama berdasarkan jumlah CD4 sebelum pengobatan ARV di RSPI Prof.DR.Sulianti Saroso, Tahun 2005-2010 = Influence of baseline CD4 cell counts on one year survival of HIV/AIDS patients with first line ARV regimen therapy at RSPI Prof.DR.Sulianti Saroso, in year 2005-2010
"Penyakit HIV/AIDS merupakan masalah kesehatan di Indonesia. Masalah yang berkembang adalah karena angka morbiditas dan mortalitas yang masih tinggi, disebabkan antara lain karena keterlambatan mendapatkan pengobatan Anti Retroviral (ARV). Di Indonesia pengobatan ARV umumnya dimulai bila jumlah sel CD4 < 200 sel/mm3 atau bila stadium klinis 3 atau 4. Informasi tentang pengaruh jumlah sel CD4 sebelum pengobatan ARV terhadap ketahanan hidup satu tahun pasien HIV/AIDS berdasarkan kelompok kategori <50 sel/mm3, 50-<200 sel/mm3 dan > 200 sel/mm3, saat ini belum tersedia di Indonesia. Untuk mengetahuinya, maka dilakukan penelitian ini.
Desain penelitian kohort retrospektif, dilakukan pengamatan terhadap kematian pada populasi dinamis selama satu tahun (366 hari), dari Januari 2005 hingga Januari 2010. Subjek penelitian 158 pasien HIV/AIDS berusia > 15 tahun, naïve dan mendapat regimen ARV lini pertama di RSPI Prof.DR.Sulianti Saroso pada tahun 2005-2010. Prosedur analisis ketahanan hidup menggunakan metode Kaplan-Meier (product limit), analisis bivariat dengan Log rank test (Mantel cox) dan analisis multivariat dengan cox regression / cox proportional hazard model.
Penelitian ini mendapatkan probabilitas ketahanan hidup keseluruhan satu tahun pasien HIV/AIDS dengan pengobatan regimen ARV lini pertama adalah 0,86 (CI 95% 0,79-0,91). Incident rate kematian (Hazard rate) kelompok jumlah sel CD4 <50 sel/mm3 adalah 8/10.000 orang hari (29/100 orang tahun), kelompok jumlah sel CD4 50-<200 sel/mm3 adalah 3/10.000 orang hari (11/100 orang tahun) dan kelompok jumlah sel CD4 > 200 sel/mm3 adalah 2/10.000 orang hari (7/100 orang tahun). Hazard Ratio(HR)-adjusted kelompok jumlah sel CD4 <50 sel/mm3 terhadap kelompok jumlah sel CD4 > 200 sel/mm3 adalah 3,4 (p= 0,058 ; CI 95% : 0,96-12,16), HR-adjusted kelompok jumlah sel CD4 50-<200 sel/mm3 terhadap kelompok jumlah CD4 > 200 sel/mm3 adalah 1,7 (p= 0,48 ; CI 95% : 0,4-7.04). HR-adjusted pasien dengan TB 3,57 kali terhadap pasien tanpa TB (p=0,015 ; CI 95% : 1,27-9,99). Jumlah sel CD4 sebelum pengobatan ARV tidak mempunyai pengaruh secara statistik terhadap ketahanan hidup satu tahun pasien HIV/AIDS yang mendapat regimen ARV lini pertama. Namun penelitian mendapatkan penyakit Tuberkulosis (TB) mempunyai pengaruh secara statistik terhadap ketahanan hidup satu tahun pasien HIV/AIDS yang mendapat regimen ARV lini pertama.
HIV/AIDS disease is one of public health concerns in Indonesia. The growing issues related to high morbidity and mortality rate. This is due to such as lately initiated of Antiretroviral (ARV) therapy. In Indonesia ARV therapy is begun when the CD4 cell counts dropped below 200 cell/mm3 or if clinical stadium fall into 3rd or 4th. Nowadays in Indonesia, Information about the influenced of baseline CD4 cell count to one year survival among patient HIV/AIDS with first line ARV regimen therapy, base on strata <50 cell/mm3, 50- <200 cell/mm3 and > 200 cell/mm3 was not available, therefore this research will be conducted.
Study design was retrospective cohort, with one year (366 days) duration of observation to death, in dynamic population from January 2005 to January 2010. The subjects of study were 158 HIV/AIDS patients, with inclusion criteria: > 15 years old, naïve, and were treated by first line ARV regimen at RSPI Prof.DR. Sulianti Saroso in year 2005-2010. The procedures of survival analysis used Kaplan-Meier method (product limit), and Log rank test (Mantel cox) for bivariate analysis and cox regression / cox proportional hazard model for multivariat analysis.
The overall of one year survival probability in HIV/AIDS patients with first line ARV regimen therapy was 0,86 (CI 95% 0,79-0,91). Incident rate of death (Hazard rate) in CD4 <50 cell/mm3 group was 8/10.000 persons days (29/100 persons years), in CD4 50-<200 cell/mm3 group was 3/10.000 persons days (11/100 persons years) and in CD4 > 200 cell/mm3 group was 2/10.000 persons days (7/100 persons years).
The Hazard Ratio(HR)-adjusted CD4 <50 cell/mm3 patients compared to CD4 > 200 cell/mm3 patients was 3,4 (p= 0,058 ; CI 95% : 0,96-12,16), the HR-adjusted CD4 50-<200 cell/mm3 patients compared to CD4 > 200 cell/mm3 patients was 1,7 (p= 0,479 ; CI 95% : 0,4-7.04). HRadjusted tuberculosis patients was 3,57 time more risk to death than patients without tuberculosis (p=0,015 ; CI 95% : 1,27-9,99).
This study found that the baseline CD4 cell counts have not significant statistical associated to one year survival of HIV/AIDS patients with first line ARV regimen therapy, after has controlled to other independent variables. But this study found that tuberculosis has significant statistical association to one year survival of HIV/AIDS patients who received first line ARV regimen therapy."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2011
T28437
UI - Tesis Open  Universitas Indonesia Library
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