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"Latar belakang: Insidensi dan faktor risiko karsinoma hepatoseluler (KSH) pada pasien hepatitis C virus (HCV) yang sudah mencapai sustained virological response (SVR) pasca terapi direct acting antiviral (DAA) belum banyak diketahui. Mengingat terdapat perbedaan jenis DAA, genotype virus, dan profil pasien di Indonesia, dilakukan studi untuk menilai insidensi dan faktor-faktor yang memengaruhi KSH pada pasien HCV pasca SVR post terapi DAA.Tujuan: Mengetahui insidensi dan faktor-faktor yang memengaruhi kejadian KSH pada pasien HCV yang mencapai SVR pasca pengobatan DAA.Metode: Desain penelitian kohort retrospektif di RSUPN Cipto Mangunkusumo, sampel pasien HCV yang SVR pasca DAA tahun 2017 – 2019, diikuti hingga 2024. Pasien dilakukan skrining USG abdomen, alpha-fetoprotein (AFP) dan CT Scan abdomen 3 fase apabila terdapat indikasi. Dilakukan analisis deskriptif, bivariat dengan Fisher’s exact, dan multivariat dengan regresi logistik bila terdapat faktor risiko di analisis bivariat (p <0,25).Hasil: Dari 180 subjek penelitian, insidensi dan rasio insidensi KSH pada seluruh populasi mencapai 4,4% (rasio insidens 0,91/100PY). Terdapat hubungan signifikan dari analisis bivariat variabel sirosis hepatis (RR 10,5; IK 95% (1,32 – 83,5); p =0,0073) dan DM tipe 2 (RR 8,47; IK 95% (2,3 – 31,1) p = 0,0048). Terdapat hubungan signifikan dari analisis multivariat variabel DM tipe 2 (aRR 3,1; IK 95% (0,86 – 3,83); p=0,002).Kesimpulan: Insidensi KSH mencapai 4,4% dari total populasi. DM tipe 2 memiliki hubungan yang signifikan terhadap kejadian KSH pada pasien HCV yang mencapai SVR pasca pengobatan DAA.

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Background: The incidence and risk factors for hepatocellular carcinoma (HCC) in hepatitis C (HCV) patients who have achieved sustained virological response (SVR) after direct-acting antiviral (DAA) therapy are not well established. Considering there are differences in DAA types, virus genotypes, and patient profiles in Indonesia, this study was conducted to assess the incidence and factors influencing HCC in HCV patients after SVR post DAA therapy.

Objective: To determine the incidence and factors influencing HCC in HCV patients achieving SVR after DAA treatment.

Method: Retrospective cohort study conducted at Cipto Mangunkusumo National General Hospital, sample of HCV patients had SVR after DAA therapy in 2017 – 2019, followed until 2024. Patients were screened for abdominal ultrasound, alpha-fetoprotein (AFP) and 3-phase abdominal CT scan, if indicated. Descriptive, bivariate analysis with Fisher's exact, and multivariate analysis with logistic regression were conducted.

Results: Among 180 subjects, the incidence and incidence ratio of HCC is 4.4% (0.91/100PY). Significant correlation in bivariate analysis from the variables liver cirrhosis (RR 10.5; CI 95% (1. 32 – 83.5); p = 0.0073) and type 2 DM (RR 8.47; CI 95% (2, 3 – 31.1) p = 0.0048). In multivariate analysis, there was significant correlation from type 2 DM variable (aRR 3.1; CI 95% (0.86 – 3.83); p=0.002).

Conclusion: The incidence of HCC reaches 4.4% of the total population. Type 2 DM has significant correlation with the incidence of HCC in HCV patients who achieve SVR after DAA treatment."

"ABSTRAKLatar Belakang: Penyakit hepatitis C kronik merupakan masalah kesehatan global yang dapat menyebabkan morbiditas serta mortalitas yang tinggi pada kondisi sirosis dan karsinoma hepatoseluler. Adanya terapi sofosbuvir-daclatasvir yang bersifat pangenotipik diharapkan dapat mengatasi penyakit ini. Namun, didapatkan hasil pencapaian SVR 12 yang bervariasi dan lebih rendah pada genotipe 3 dibandingkan genotipe 1. Di Indonesia sendiri belum ada data mengenai pencapaian SVR 12 pada kedua genotipe ini yang menggunakan terapi sofosbuvir-daclatasvir. Tujuan: Mengetahui pencapaian SVR 12 pasien hepatitis C Kronik genotipe 3 dibandingkan genotipe 1 yang mendapatkan terapi sofosbuvir-daclatasvir.Metode: Penelitian ini merupakan studi kohort retrospektif dengan menggunakan data sekunder yang melibatkan 209 pasien hepatitis C kronik genotipe 3 dan 1. Dilakukan analisis dengan membagi pasien menjadi dua kelompok yaitu genotipe 3 dan 1 serta dibandingkan dengan pencapaian keberhasilan SVR 12 menggunakan uji chi-square. Faktor sirosis hepatis dan usia yang dianggap dapat memengaruhi keberhasilan SVR 12 dianalisis dengan menggunakan uji chi-square kemudian dilanjutkan dengan analisis regresi logistik.Hasil: Sampel berjumlah 209 pasien yang terdiri dari 45 pasien genotipe 3 dan 164 pasien genotipe 1. Pencapaian keberhasilan SVR 12 pada genotipe 3 dan 1 yaitu 84,4% dan 98,8%. Kelompok pasien genotipe 3 memiliki keberhasilan SVR 12 lebih rendah dibandingkan kelompok pasien genotipe 1 dengan adjusted OR=0,065 (IK95% 0,013-0,330) dan ARR 14,4%. Sirosis hepatis dan usia tidak memengaruhi keberhasilan SVR 12 (p=1,00 dan p=0,72). Sejumlah 5 dari 9 pasien yang mengalami kegagalan memiki koinfeksi dengan HIV. Simpulan: Pasien hepatitis C kronik genotipe 3 yang menggunakan terapi sofosbuvir-daclatasvir memiliki keberhasilan SVR 12 lebih rendah dibandingkan genotipe 1.

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ABSTRACTBackground. Chronic hepatitis C is a global health problem with high morbidity and mortality in the condition of cirrhosis and hepatocellular carcinoma. sofosbuvir-daclatasvir is pangenotypic therapy that expected to overcome this disease. However, the achievement of SVR 12 was varied and lower in genotype 3 compared to genotype 1. In Indonesia, there is no data about achievement SVR 12 in both genotypes using sofosbuvir-daclatasvir.Objectives. To know SVR 12 achievement between genotype 3 and 1 chronic hepatitis C patients that using sofosbuvir-daclatasvir therapy.Methods. This study is a retrospective cohort using secondary data of 209 hepatitis C chronic genotype 3 and 1. Samples were divided into two groups according to its genotype and compared with achievement of SVR 12 then analyzed using chi-square test. Hepatic cirrhosis and age factors that are considered to affect the achievement SVR 12 were analyzed using chi-square test and logistic regression test.Results. 209 patients participated in this study consisting of 45 genotype 3 and 164 genotype 1. Achievement of SVR 12 succeed in genotypes 3 and 1 were 84,4% and 98,8%. Genotype 3 patients had lower SVR 12 achievement compared to genotype 1 patients with adjusted OR=0,065 (95% CI 0,013-0,330) and ARR 14,4. Hepatic cirrhosis and ages did not affect SVR 12 (p= 1.00 and 0,72, respectively). Five from nine patients who failed have co-infection with HIV.Conclusions. Chronic hepatitis C patients using sofosbuvir-daclatasvir theraphy had lower SVR 12 achievement in genotype 3 than genotype 1."

"ABSTRAK<

Karsinoma hepatoseluler (KHS) merupakan karsinoma primer tersering pada sel hati. Sebagian besar KHS disebabkan oleh virus hepatitis B (VHB) dan virus hepatitis C (VHC) yang memiliki patogenesis yang berbeda dalam menyebabkan KHS. Alfa-fetoprotein (AFP) sebagai penanda tumor pada KHS dan dipengaruhi oleh berbagai faktor, salah satunya status infeksi. Berbagai penelitian sudah dilakukan untuk mengetahui pengaruh pengaruh jenis virus penyebab KHS dengan kadar AFP namun hasilnya sangat beragam. Berdasarkan hal tersebut dan ditambah dengan belum adanya penelitian serupa yang menggunakan data pasien di Indonesia maka penelitian ini bertujuan untuk membandingkan kadar AFP pada pasien KHS terkait infeksi VHB terhadap VHC. Penelitian ini dilakukan dengan desain studi potong lintang menggunakan 199 data AFP pasien KHS yang terdiri dari 129 kasus KHS terkait VHB dan 70 kasus KHS terkait VHC. Dari penelitian ini didapatkan sebanyak 97% dan 87.3% pasien KHS terkait VHC dan VHB mengalami peningkatan kadar AFP secara berurutan. Nilai median kadar AFP pada pasien KHS terkait VHB adalah 419 IU/mL sedangkan pada pasien KHS terkait VHC sebesar 400 IU/mL. Perbedaan nilai tersebut memiliki nilai p = 0.97 dalam uji Mann-Whitney U sehingga disimpulan tidak ada perbedaan bermakna pada rerata kadar AFP antara pasien KHS terkait VHB dibanding dengan VHC.

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ABSTRACT

Hepatocellular carcinoma (HCC) is the most primary common carcinoma in liver cells. Most HCC are caused by the hepatitis B virus and hepatitis C that have different pathogenesis in causing carcinoma. Alpha-fetoprotein as tumor marker in HCC is influenced by various factors, one of which is infection status. Various studies have been carried out to determine the influence of the types of viruses causing HCC with AFP levels but the results are very diverse. Based on this and coupled with the absence of similar studies using patient data in Indonesia, this study aims to compare AFP levels in HCC patients related to HBV and HCV. Using cross-sectional design, this study included 199 data of AFP in patient with HCC comprises of 129 cases of HCC related to HBV and 70 cases of HCC related to HCV. From this study, it was found that 97% and 87.3% of HCC patients related to HCV and HBV experienced an increase in AFP levels consecutively. The median value of AFP levels in HBV-related HCC patients was 419 IU / mL while in HCV-related HCC patients was 400 IU / mL. The difference in value has a p value = 0.97 in the Mann-Whitney U test thus it is concluded that there is no significant difference in AFP levels between HBV-related HCC patients compared with HCV-related HCC.

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"[ABSTRAKLatar Belakang. SNP IL-28B mempunyai peran penting dalam pencapaian SVR pada pengobatan Hepatitis C kronik antarras manusia dan berpotensi untuk memprediksi keberhasilan terapi Peg-IFN/RBV maupun penyembuhan spontan Hepatitis C akut. Hingga saat ini, mekanisme molekular yang mendasari kaitan SNP IL-28B dengan respons terapi masih belum jelas meskipun diperkirakan terkait dengan ekspresi IFN-l3 dan reseptor IFN-l3 di jaringan hati.Tujuan. Mengetahui hubungan SNP IL-28B dan SVR serta ekspresi IFN-l3 dan reseptor IFN-l3 di jaringan hati serta mendapatkan kemaknaan klinis SNP IL-28B dan kovariat SVR dalam memprediksi respons terapi Peg-IFN/RBV.Metode. Penelitian ini terbagi menjadi dua bagian. Pertama, penelitian potong lintang pada pasien Hepatitis C kronik yang telah selesai menjalani terapi Peg-IFN/RBV dengan melakukan pengambilan data dasar dan sampel darah. Kedua, penelitian kasus kontrol pasien yang menjalani biopsi hati dan pewarnaan imunohistokimia.Hasil. Pencapaian SVR yang lebih tinggi ditemukan pada pasien dengan alel CC SNP IL28B (p=0,014). Alel CC SNP IL28B mempunyai ekspresi IFN-l3 lebih tinggi dibandingkan dengan alel non-CC (p = 0,018). Meskipun demikian, tidak ditemukan adanya perbedaan bermakna antara ekspresi IFN-l3 (p = 0,237) maupun reseptor IFN-l3 dengan SVR (p = 0,237). Pada penelitian ini, diformulasikan persamaan faktor risiko pencapaian SVR sebagai p = 1 / (1 + e-y); e = 2,7, y = -2,498 + 2,652 (SNP IL-28B) + 2,029 (trombosit) untuk praterapi dan sedangkan untuk masa terapi y = -0,223 + 2,621 (RVR).Simpulan. SNP IL-28B merupakan faktor risiko praterapi yang penting dalam pengobatan hep C kronik G1 menggunakan terapi dua kombinasi. Alel mayor IL28B mengekspresikan IFN-l3 dan reseptornya lebih banyak sebagai respons adanya VHC, namun tidak ditemukan adanya hubungan hal tersebut dengan pencapaian SVR. RVR merupakan faktor masa terapi terbaik untuk memprediksi SVR. Penelitian lanjutan diperlukan untuk membuktikan adanya faktor lain yang berperan dalam pencapaian SVR.;

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ABSTRACTBackground: SNP IL-28B played an important role in achieving sustained virological response (SVR) among different ethnics in chronic Hepatitis C patients and is considered potential in predicting treatment response of Pegylated interferon/ribavirin (Peg-IFN/RBV) combination and spontaneous clearance in acute hepatitis. Up to date, molecular mechanism underlying correlation between SNP IL28B and SVR has not been fully understood yet although it is predicted to be related to IFN-λ3 and IFN-λ3 receptor in liver tissues.Aim: Understanding the association between SNP IL-28B and SVR in chronic Hepatitis C treatment and expression of IFN-l3 and IFN-l3 receptor in liver tissues to evaluate clinical importance of SNP IL-28B examination in Hepatitis C treatment of Peg-IFN/RBV through SVR prediction model.Methods: This study consisted of two parts. First, a cross-sectional study on chronic Hepatitis C patients who completed Peg-IFN/RBV therapy. The second part was case control study on patients underwent liver biopsy and immunohistochemical staining.Results: Sustained virological response was significantly higher in CC allele of SNP IL-28B compared to non CC allele (p = 0.015). Higher expression of IFN-l3 was found in CC allele compared to non CC allele (p = 0.018). On the other hand, there is no significant difference between SVR and expression of IFN-l3 (p = 0.237) and IFN-l3 receptor (p = 0.237). Risk factor for SVR probability were formulated into p = 1 / (1 + e-y); e = 2.7, y = -2.498 + 2.652 (SNP IL-28B) + 2.029 (thrombocytes) for pretreatment while for on treatment risk factor y = -0.223 + 2.621 (RVR)Conclusion: SNP IL-28B was important pretreatment risk factor in genotype 1 chronic Hepatitis C treated with dual therapy. Major allele of IL-28B expressed more IFN-l3 and its receptor in response to HCV although no association between both factors was found. RVR was the best on treatment factor for SVR. Further evaluation study was required to find other possible factors affecting SVR achievement, Background: SNP IL-28B played an important role in achieving sustained virological response (SVR) among different ethnics in chronic Hepatitis C patients and is considered potential in predicting treatment response of Pegylated interferon/ribavirin (Peg-IFN/RBV) combination and spontaneous clearance in acute hepatitis. Up to date, molecular mechanism underlying correlation between SNP IL28B and SVR has not been fully understood yet although it is predicted to be related to IFN-λ3 and IFN-λ3 receptor in liver tissues.Aim: Understanding the association between SNP IL-28B and SVR in chronic Hepatitis C treatment and expression of IFN-l3 and IFN-l3 receptor in liver tissues to evaluate clinical importance of SNP IL-28B examination in Hepatitis C treatment of Peg-IFN/RBV through SVR prediction model.Methods: This study consisted of two parts. First, a cross-sectional study on chronic Hepatitis C patients who completed Peg-IFN/RBV therapy. The second part was case control study on patients underwent liver biopsy and immunohistochemical staining.Results: Sustained virological response was significantly higher in CC allele of SNP IL-28B compared to non CC allele (p = 0.015). Higher expression of IFN-l3 was found in CC allele compared to non CC allele (p = 0.018). On the other hand, there is no significant difference between SVR and expression of IFN-l3 (p = 0.237) and IFN-l3 receptor (p = 0.237). Risk factor for SVR probability were formulated into p = 1 / (1 + e-y); e = 2.7, y = -2.498 + 2.652 (SNP IL-28B) + 2.029 (thrombocytes) for pretreatment while for on treatment risk factor y = -0.223 + 2.621 (RVR)Conclusion: SNP IL-28B was important pretreatment risk factor in genotype 1 chronic Hepatitis C treated with dual therapy. Major allele of IL-28B expressed more IFN-l3 and its receptor in response to HCV although no association between both factors was found. RVR was the best on treatment factor for SVR. Further evaluation study was required to find other possible factors affecting SVR achievement]"

"[Association between SNP IL-28B and Sustained Virological Response and Its Relation with Expression of Interferon Lambda-3 and Interferon Lambda-3 Receptor in Liver Tissues of Chronic Hepatitis C Patients Treated with Pegylated Interferon α2 and Ribavirin;Association between SNP IL-28B and Sustained Virological Response and Its Relation with Expression of Interferon Lambda-3 and Interferon Lambda-3 Receptor in Liver Tissues of Chronic Hepatitis C Patients Treated with Pegylated Interferon α2 and Ribavirin, Association between SNP IL-28B and Sustained Virological Response and Its Relation with Expression of Interferon Lambda-3 and Interferon Lambda-3 Receptor in Liver Tissues of Chronic Hepatitis C Patients Treated with Pegylated Interferon α2 and Ribavirin]"

"Karsinoma hepatoseluler (KHS) adalah salah satu kanker dengan laju mortalitas tertinggi di dunia. Kadar serum alfa-fetoprotein (AFP) dapat digunakan sebagai biomarker untuk menegakkan diagnosis dini. Tetapi, perbandingan antara kadar serum AFP dan KHS dengan etiologi infeksi virus dan etiologi non infeksi virus belum diketahui. Mengetahui perbandingan antara kadar serum AFP dan KHS dengan etiologi infeksi virus dan etiologi non infeksi virus. Penelitian potong lintang dilakukan di RSUPN Cipto Mangunkusumo, Jakarta pada Januari-Oktober 2018 dengan melihat data rekam medis dari 287 pasien yang terdiagnosis KHS dalam periode 2013-2017. Nilai median (minimum-maksimum) dari kadar AFP pada pasien KHS dengan etiologi infeksi VHB atau VHC adalah 419 (0.8-400.000). Nilai median (minimum-maksimum) kadar AFP pada pasien KHS dengan etiologi non infeksi VHB-VHC adalah 7.18 (0.6-90.944). Terdapat perbedaan bermakna antara kadar AFP dengan KHS dengan etiologi infeksi VHB atau VHC dan etiologi non infeksi VHB-VHC.

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Hepatocellular carcinoma (HCC) is one of the highest rates of mortality in the world. Serum alpha-fetoprotein (AFP) levels can be used as a biomarker for early diagnosis. However, the comparison between serum AFP and HCC with viral infections etiology and non-viral etiology is unknown. This research aims to determine the comparison between serum AFP and HCC with viral infections etiology and non-viral aetiology. A cross-sectional study conducted in Cipto Mangunkusumo Hospital, Jakarta in January to October 2018 by reviewing 287 medical records of patients diagnosed with HCC from 2013-2017 period of time. The median (minimum-maximum) value of AFP levels in HCC patients with the etiology of HBV or HCV infection is 419 (0.8-400,000). The median value (minimum-maximum) of AFP levels in HCC patients with the etiology of non HBV-HCV infection was 7.18 (0.6-90,944). There were significant differences between AFP levels and KHS with the etiology of HBV or HCV infections and the etiology of non HBV-HCV infections."

"Latar Belakang: Hepatitic C merupakan penyakit yang disebabkan oleh Virus Hepatitis C (HCV) dan dapat mengakibatkan peradangan hati, biasanya bersifat asimtomatik, bahkan kronik yang ditandai dengan sirosis, kanker hati, kelainan fungsi hati yang dapat menyebabkan kematian. Pengobatan standar dengan PEGinterferon-a dan ribavirin memiliki efek samping yang berat, sehingga diperlukan pengobatan alternatif sebagai anti-HCV. Dimocarpus longan merupakan tanaman yang memiliki khasiat sebagai antijamur, antivirus, antiinflamasi, antioksidan, antibakteri, dan antikanker. Tujuan penelitian ini untuk mengetahui efek dan mekanisme kerja ekstrak metanol daun D. longan terhadap virus Hepatitis C.Metode: Cell line derivate Human hepatocarcinoma (Huh 7it-1) diinfeksikan dengan HCV strain JFH1 dari genotipe 2a yang diinduksikan ekstrak metanol daun D. longan selama dua hari, kemudian diukur virus yang terbentuk ekstraseluler dan intraseluler. Pemeriksaan virus ekstraseluler dengan cara focus forming assay sedangkan intraseluler dengan qRT-PCR, western blot dan relative fluorescence assay. Pengujian sitotoksisitas terhadap Huh 7it-1 dengan metode MTT assay. Ekstrak metanol daun D. longan diuji adanya kandungan saponin, flavonoid, triterpenoid dan steroid, tanin, dan glikosida.Hasil: Konsentrasi hambatan 50% (IC50) ekstrak terhadap HCVsebesar 13,2 ± 0,52 μg/ml dan toksik 50% (CC50) terhadap sel Huh 7it-1 sebesar 681,9 ± 13,2 μg/ml dengan nilai indek selektivitas (SI) sebesar 51,2. Efek virusidal ekstrak metanol daun D. longan secara langsung terhadap HCV berupa pengurangan titer virus sebesar 99%. Analisis RNA dan protein NS3 HCV intraseluler memperlihatkan adanya hambatan sebesar 20%. Kandungan fitokimia yang terdapat pada ekstrak metanol daun D. longan di antaranya saponin, flavonoid, triterpenoid dan steroid, alkaloid, tanin, dan glikosida.Kesimpulan: Mekanisme anti-HCV dari ekstrak metanol daun D. longan diduga melalui adanya hambatan pada entry dan post-entry yang bekerja dengan menghambat pada penempelan virus, membunuh virus dengan interaksi langsung, menghambat ekspresi NS3, dan menghambat replikasi. Kandungan fitokimia yang terkandung seperti saponin, flavonoid, triterpenoid dan steroid, tanin, dan glikosida.

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Background: Hepatitic C is a disease caused by the hepatitis C virus (HCV). HCV infection can lead to inflammation of liver tend to be asymptomatic, and chronic characterized by cirrhosis, liver cancer, abnormal liver function can cause mortality. Standard HCV treatment with PEG-interferon-a and ribavirin have severe side effects, necessitating alternative treatments as anti-HCV. Dimocarpus longan is a plant that previously reported has antifungal, antiviral, anti-inflammatory, antioxidant, antibacterial, and anticancer activity. The purpose of this study is determine the effects and mechanism of action of the methanol extract of leaves of D. longan against hepatitis C virus.Methods: A derivate of Human hepatocarcinoma Cell line (Huh 7it-1) was infected with HCV of genotype 2a JFH1 strain which is inducted with methanol extracts of D. longan for two days and then number of virus produced outside of the cell (extracellular) and inside of the cell (intracellular) were measured by focus forming assay, while intracellular virus was measured by qRT-PCR, western blot and relative fluorescence assay. Cytotoxicity against Huh 7it-1 was tested by MTT assay. Examination of phytochemical content D. longan showed the presence of saponins, flavonoids, triterpenoids and steroids, alkaloids, tannins, and glycosides.Result: D. longan concentration of inhibition 50% (IC50) and Toxic effects of concentration of cytotoxicity 50% (CC50) againts cells Huh 7it-1were obtained 13,2 ± 0.52 ug/ml and 681.9 ± 13.2 ug/ml, respectively and with selectivity index (SI) 51.2. Result of direct virucidal effect was shown inhibition of titer virus 99%. RNA and NS3 protein analysis of HCV were shown inhibition 20%. Phytochemical contains of methanol extracts of Dimocarpus longan Lour. Leaves are saponins, flavonoids, triterpenoids and steroids, tannins, and glycosides.Conclusion: Anti-HCV mechanisms of methanol extracts of Dimocarpus longan Lour. Leaves are inhibition at entry and post-entry with action at attachment, direct killing, inhibition of expression NS3, and replication. Phytochemical content in the methanol extract of leaves of D. longan were saponins, flavonoids, triterpenoids and steroids, tannins, and glycosides."

"[Latar Belakang: Ko-infeksi dengan human immunodeficiency virus (HIV) pada infeksi virus hepatitis C memiliki angka mortalitas dan morbiditas yang tinggi. Salah satu defek imunologik yang terjadi pada ko-infeksi ini ialah dalam hubungannya dengan populasi sel NK (CD56+CD3-) dan NKT (CD56+CD3+) di hati, yang dalam keadaan normal berperan penting dalam jejas di hati dan fibrogenesis. Kedua populasi sel ini dikatakan menurun dan mengalami disfungsi pada ko-infeksi ini dan dikaitkan dengan progresivitas penyakit serta fibrosis di hati. Pemberian Anti Retroviral Therapy (ART) diharapkan dapat memperbaiki defek imunologik pada kedua populasi sel ini. Immune restoration disease (IRD) virus hepatitis C merupakan salah satu efek samping pemberian ART pada ko-infeksi ini dan mungkin melibatkan kedua populasi sel tersebut.Bahan dan Metode: Pulasan imunohistokimia dengan CD56 dilakukan pada 39 spesimen biopsi pasien sebelum pemberian ART dan 26 spesimen setelah pemberian ART selama 48 minggu. Parameter klinik dan histopatologik dari penelitian sebelumnya dicatat. Rerata sel limfosit CD56+ dihitung dalam 3-5 area porta yang terlihat.Hasil: Rerata sel limfosit CD56+ tidak meningkat setelah pemberian ART (p=0,35) dan tidak menunjukkan korelasi baik dengan skor fibrosis, jumlah sel T CD4+ di darah tepi, viral load HIV dan viral load virus hepatitis C. Tidak didapatkan pula perbedaan rerata sel limfosit CD56+ antara kelompok dengan dan tanpa IRD virus hepatitis C.Kesimpulan: Ko-infeksi HIV dan virus hepatitis C mungkin memiliki efek permanen pada sel NK dan NKT di hati dan pemberian ART saja tidak dapat mengembalikan jumlah kedua populasi sel tersebut., Background: Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection has a high mortality and morbidity rate. One of the immunological defects in this coinfection is in NK (CD56+CD3-) and NKT (CD56+CD3+) cells population in the liver, which in normal condition have important role in liver injury and fibrogenesis. Both cell populations decrease in numbers and have dysfunction in this coinfection and are related with disease progression and fibrosis in the liver. Anti retroviral therapy (ART) given to coinfected patients is expected to repair immunological defect in both NK and NKT cell populations. HCV immune restoration disease (IRD) is one of the side effects of ART in this coinfection and may also involve both cell populations.Materials and methods: Immunostaining with CD56 was performed on 39 biopsy samples of coinfected patients at baseline and 26 biopsy samples after 48 weeks of ART. Both clinical and histopathological parameters from previous study were noted. Means of CD56+ lymphocyte were counted over 3-5 portal areas.Result: Means of CD56+ lymphocyte counts did not increase after ART (p=0.35) and did not correlate with fibrotic score, CD4+ T cell count in peripheral blood, and neither with HIV and HCV viral load. There was no difference in CD56+ lymphocytes count between HCV IRD and non HCV IRD group.Conclusion: HIV/HCV coinfection might have permanent effect on both NK and NKT cells population and ART alone can not reverse NK and NKT cell numbers in this coinfection.]"

"Latar belakang: Pasien dengan HBK yang mendapat terapi antivirus perlu mendapat pemantauan secara teratur. Penelitian ini bertujuan untuk mengetahui perubahan derajat kekakuan hati dengan transient elastography (TE) dan APRI sebelum dan setelah menjalani terapi minimal 1 tahun pada pasien Hepatitis B kronik dan korelasi antara TE dan APRI. Metode: Penelitian ini adalah studi before-and-after treatment dengan melihat perubahan nilai derajat kekakuan hati dan APRI antara sebelum dan sesudah terapi. Pasien hepatitis B kronik yang pernah menjalani pemeriksaan TE dan APRI awal dan menjalani terapi antivirus setelah satu tahun dilakukan pemeriksaan TE ulang dan APRI ulang. Hasil penelitian: Data dari 41 pasien ini didapatkan hasil median derajat kekakuan hati awal adalah 10,8 kPA dan setelah terapi satu tahun terdapat penurunan menjadi 5,9 kPa dan penurunan derajat kekakuan hati ini bermakna dengan p < 0,001. Median APRI awal adalah 1,13 dan setelah terapi antivirus terdapat penurunan menjadi 0,43 dan penurunan ini bermakna dengan p < 0,001.Dari nilai transient elastography dan APRI didapatkan koefisien korelasi pra-terapi dengan r =0,399 dan setelah terapi antivirus koefisien korelasi r = 0,731. Simpulan: Derajat kekakuan hati yang diukur dengan transient elastography dan APRI turun secara bermakna setelah terapi antivirus satu tahun pada pasien hepatitis B kronik. Nilai Transient elastography dan APRI mempunyai korelasi moderat sebelum terapi dan korelasi yang kuat setelah terapi satu tahun.

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Aim: This study was intended to know the changes of the liver stiffness by transient elastography (TE) and APRI before and after treament at least one year in HBV patients for monitoring the treatment result and correlation between TE and APRI.

Methods: Data were collected from 41 HBV patients with and by using before-and-after treatment method to assess the changes of the liver stiffness and APRI after one year of treatment.The patients were perfomed TE and APRI before and after one year of treatment. The patients were excluded if had infection of HCV or HIV, failure of the procedure, the worsening of hepatitis like acute excacerbation and HCC.

Results: The median liver stiffness measured by TE was significanly decreased from 10,8 kPA to 5,9 kPa after one year of antiviral treatment with p < 0,001. The median value of APRI before treatment was 1,13 and decreased significantly after treatment to 0.43 and with p < 0,001. The correlation between liver stiffness and APRI before treatment were moderate with r = 0,399 and after treatment the correlation were stronger with r = 0,731.

Conclusion: The liver stiffness that measured with transient elastography and APRI significantly decrease after one year of antiviral treatment in chronic HBV patients. There was a moderate correlation between TE and APRI before treatment and strong correlation after one year of treatment."