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"ABSTRAKPendahuluan: Pasien HIV/Aquired immunedeficiency syndrome (AIDS) lebih berisiko untuk terinfeksi tuberkulosis (TB) dan mengalami progresifitas menjadi TB aktif lebih besar dibandingkan dengan orang yang tidak terinfeksi HIV. Pasien HIV tanpa bukti adanya TB aktif dianggap sebagai TB laten dan dilakukan pemberian isoniazid preventive therapy (IPT). Salah satunya cara diagnosis TB laten adalah dengan pemeriksaan IGRA. TSPOT®.TB adalah IGRA metode ELISPOT, mengukur jumlah limfosit T yang memproduksi interferon gamma (IFN-γ) setelah stimulasi oleh antigen spesifik Mycobacterium tuberculosis compex (MTB) yaitu ESAT-6 (panel A) dan CFP-10 (panel B). Penelitian ini bertujuan untuk melihat bagaimana hasil IGRA metoda ELISPOT pada pasien HIV-TB aktif dan pasien HIV-TB laten di Pokdisus RSCM.Metode: Rancangan penelitian ini adalah potong lintang. Subjek penelitian terdiri dari 3 pasien HIV-TB aktif dan 31 pasien HIV-TB laten yang dilakukan pemeriksaan IGRA metode ELISPOT.Hasil: Gejala klinis terdapat pada semua subyek HIV-TB aktif yaitu batuk ≥ 2 minggu, demam, dan penurunan berat badan, sedangkan pada HIV-TB laten gejala klinis terjadi pada 3/31 subyek (9.7%). Pemeriksaan yang medukung diagnosis TB aktif yaitu tuberculin skin test (TST), foto paru, GeneXpert MTB/RIF, dan hasil Patologi Anatomi (PA). Pemeriksaan sputum basil tahan asam (BTA) tidak ditemukan pada semua subyek TB aktif. Hasil IGRA positif pada 10/31 subyek (32.3%) di kelompok HIV-TB laten dan 2/4 subyek pada kelompok HIV-TB aktif. Rerata spot panel A (ESAT-6) pada kelompok HIV-TB aktif adalah 37.75 (SD 46.0) spot, dan panel B (CFP-10) rerata 10.7 (SD15.3) spot. Kelompok HIV-TB laten memiliki median 1.5 (rentang 0-92 spot) untuk panel A, dan panel B median 3.0 ( rentang 0-479 spot).Kesimpulan: Pasien HIV-TB aktif lebih banyak mengalami gejala klinis dari pada pasien HIV-TB laten. Diagnosis TB aktif pada pasien HIV lebih banyak ditegakan berdasarkan klinis karena konfirmasi bakteriologis sulit ditemukan. Hasil IGRA positif ditemukan pada 2/4 subyek HIV-TB aktif, 32,3% pada subyek HIV-TB laten, dan jumlah spot belum dapat digunakan untuk menentukan HIVTB aktif dengan HIV-TB laten.

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ABSTRACT

Introduction. HIV/ Aquired immunedeficiency syndrome (AIDS) patients has a bigger risk to get infected by tuberculosis (TB) and progressed to active TB infection more than a people who without HIV infected. HIV patients without vidence of active TB infection are presumed as latent TB infection and need to be given isoniazid preventive theraphy (IPT). Interferon-gamma release assay which is available for identification latent TB infection, are in vitro blood test of cellmediated immune response; measuring T-cell release of IFN- γ following stimulation by antigents specific to the M. tuberculosis complex i.e ESAT-6 and CFP-10. The objective of this study is to investigate IGRA ELISPOT method in HIV-active TB infection and HIV-latent TB infection in Pokdisus RSCM

Methods. This study was cross-sectional study. Interferon-gamma release assay ELISPOT method was performed on 4 HIV-active TB infection and 31 HIVlatent infection.

Results. All subjects with HIV-active TB had clinical manifestations such as cough more than 2 weeks, fever and weight loss, but only 3/31 (9,7%) HIV-latent TB subjects had clinical manifestation. Other assay supporting active TB diagnosis such as tuberculin skin test (TST), chest X-ray, GeneXpert MTB/RIF and biopsies were not found in all active TB subjects. Interferon-gamma release assay was positive in 10/31 subjects (32.2%) in the HIV-active TB group and 2/4 subjects in the HIV-latent TB group. Mean spot panel A(ESAT-6) and panel B (CFP-10 in HIV-active TB are 37.75 (SD 46.0) spot and 10,7 (SD 15.3) spot. Median spot panel A and panel B in HIV-latent TB are 1.5 (range 0-92) spot and 3.0 (range 0-479) spot.

Conclusion. patients with HIV-active TB has more clinical manifestation compared to HIV-latent TB patients. Active TB status more often diagnosed from clinical manifestation, because bacteriological confirmation were hard to find on patiens with HIV. IGRA positive result were found 2/4 subject with active TB patients, 32.3% in subject with latent TB, and spot count cannot yet be used for differentiating HIV-active TB from HIV-latent TB status."

"Telah dilakukan suatu penelitian eksperimental untuk menilai peran sel T regulator pada pasien dengan ko-infeksi HIV-TB. Terhadap 18 subyek HIV positif dilakukan penilaian IGRA, isolasi dan kultur PBMC dengan stimulasi antigen MTB, serta sorting dan deplesi Treg CD4 CD25highCD127low dengan metode FACS. Produksi sitokin IFN- dan IL-10 dinilai secara kuantitatif dengan multiplex Luminex 200. Diperoleh sebanyak 10 55,6 subyek TB negatif, 6 33,3 subyek TB laten, dan 2 11,1 subyekTB aktif. Persentase Treg dari CD4 pada subyek HIV dengan status TB menunjukkan kenaikan signifikan dibanding nilai referensi batas atas persentase Treg dalam CD4 subyek normal 11,006 2,840 ; p=0,008 . Rerata persentase Treg dari sel PBMC total antara kelompok TB aktif dan TB negatif menunjukkan perbedaan yang signifikan 1,3 vs 0,8 ; p=0,036 . Tidak terdapat perbedaan rasio sitokin proinflamasi INF- terhadap sitokin anti inflamasi IL-10 pada kelompok dengan ko infeksi HIV- TB aktif dan laten sebelum dan sesudah deplesi Treg.

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An experimental study has been conducted to assess the role of T regulatory cells in patients with HIV TB co infection. 18 HIV positive subjects undergo IGRA assessment, PBMC isolation and culture with ESAT 6 CFP 10 mycobacterial antigen stimulation, and Treg CD4 CD25highCD127low sorting and depletion by FACS method. The production of cytokines IFN and IL 10 were quantitatively assessed with Luminex 200 multiplex assay. Respectively, 10 55.6 were negative TB subjects, 6 33.3 were latent TB subjects, and 2 11.1 subjects were TB active. The percentage of Treg from CD4 cells in HIV subjects with TB status showed a significant increase over the reference value in normal subjects 11.006 2.840 p 0.008 . The mean percentage of Treg from total PBMC cells between active and negative TB groups showed a significant difference 1.3 vs. 0.8 p 0.036 . There was no difference in the ratio of proinflammatory cytokines INF to the anti inflammatory cytokine IL 10 in the group with active and latent HIV TB infection coinfection before and after Treg depletion. "

"Kepatuhan minum obat disertai keadekuatan penerimaan diri status HIV menjadi tantangan pasien TB HIV. Kepatuhan minum obat memiliki hubungan positif dengan tingkat penerimaan diri (self-acceptance). Terapi SEFT (Spiritual Emotional Freedom Technique) merupakan intervensi non farmakologis sebagai salah satu terapi komplementer berpotensi meningkatkan kepatuhan minum obat dan self-acceptance HIV. Tujuan penelitian untuk mengidentifikasi pengaruh terapi SEFT terhadap kepatuhan minum obat dan self acceptance HIV. Desain penelitian quasi eksperiment, metode pre test-post test dengan purposive sampling sebesar 34 responden, dibagi 2 kelompok, tiap kelompok berjumlah 17. Kelompok 1 mendapatkan terapi SEFT, dan kelompok 2 perawatan standar edukasi.  Hasil uji paired t test, terdapat peningkatan kepatuhan minum obat dan self acceptance HIV sesudah diberikan terapi SEFT pada kelompok 1 (p value=0,0001). Pada uji independent t test terdapat peningkatan signifikan kepatuhan minum obat dan self acceptance HIV sesudah diberikan terapi SEFT pada kelompok 1 dibandingkan kelompok 2 (p value=0,0001). Variabel confounding paling berpengaruh adalah pendapatan. Hasil analisis regresi linier berganda menunjukkan seluruh variabel confounding, yaitu pendidikan, pekerjaan, pendapatan dan efek samping menjelaskan self acceptance HIV setelah terapi SEFT sebesar 54%, kepatuhan minum obat sebesar 50,5%. Terapi SEFT berpengaruh terhadap peningkatan kepatuhan minum obat dan self acceptance HIV, dapat direkomendasikan sebagai salah satu tata laksana TB HIV.

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Medication adherence along with self-acceptance of HIV status is a challenge for HIV TB patients. Adherence to taking medication has a positive relationship with the level of self-acceptance. SEFT (Spiritual Emotional Freedom Technique) therapy is a non-pharmacological intervention as one of the complementary therapies that has the potential to improve adherence to taking medication and HIV self-acceptance. The purpose of the study was to identify the effect of SEFT therapy on medication adherence and HIV self-acceptance. Quasi-experiment research design, pre-test-post test method with purposive sampling of 34 respondents, divided into 2 groups, each group numbered 17. Group 1 received SEFT therapy, and group 2 standard educational treatment.  The results of the paired t test, there was an increase in drug compliance and HIV self-acceptance after being given SEFT therapy in group 1 (p value = 0.0001). In the independent t test, there was a significant increase in medication adherence and HIV self-acceptance after SEFT therapy in group 1 compared to group 2 (p value=0.0001). The most influential confounding variable was income. The results of multiple linear regression analysis showed that all confounding variables, namely education, occupation, income and side effects explained HIV self acceptance after SEFT therapy by 54%, drug compliance by 50.5%. SEFT therapy has an effect on increasing adherence to taking medication and HIV self acceptance, can be recommended as one of the management of HIV TB."

"Infeksi HIV dan bakteri Mycobacterium tuberculosis (Mtb) telah lama dianggap sebagai faktor risiko dari satu sama lain. Penelitian ini merupakan observasi potong lintang terhadap rekam medis dari pasien poliklinik paru RSUP Persahabatan selama bulan September-Oktober 2018. Pengambilan sampel dilakukan secara acak konsekutif. Hasil penelitian menemukan 94 pasien TB paru tanpa koinfeksi HIV (22 BTA positif, 72 BTA negatif; 52 lesi paru luas, 42 lesi paru minimal pada diagnosis) dan 14 pasien TB paru dengan koinfeksi HIV (1 BTA positif, 13 BTA negatif; 8 lesi paru luas, 6 lesi paru minimal pada diagnosis). Penelitian menemukan bahwa pasien infeksi TB tanpa HIV cenderung memiliki hasil BTA negatif yang tidak signifikan secara statistik (OR=0,202, p=0,163). Infeksi TB tanpa HIV memiliki kecenderungan sedikit lebih rendah untuk mengalami lesi paru minimal, namun tidak signifikan secara statistik (OR=0,941, p=1). Dari penelitian ini, dapat disimpulkan bahwa koinfeksi HIV pada TB paru tidak menyebabkan perbedaan kecenderungan Bacterial Load yang signifikan.

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HIV Infection and Mycobacterium tuberculosis (Mtb) infection has long been thought as a risk factor of each other. This study is a cross-sectional observation of the medical records of RSUP Persahabatan Lung Polyclinics patients in September-October 2018. The sampling was done using the consecutive random sampling method. The study found 94 pulmonary Tuberculosis patients without HIV coinfection (22 positive AFB, 72 negative AFB; 52 extensive lung lesion, 42 minimal lung lesion) and 14 pulmonary Tuberculosis patients with HIV coinfection (1 positive AFB, 13 negative AFB; 8 extensive lung lesion, 6 minimal lung lesion).

This study found that lung TB without HIV infection is a statistically insignificant risk factor of positive AFB result (OR=0.202, p=0.163). TB infection without HIV also has a slightly lower odd of having minimal lung lesion, however, this is neither statistically nor clinically significant. From this study, it can be inferred that HIV coinfection in pulmonary TB does not cause significant difference in Bacterial Load tendency."

"Latar belakang : penegakkan diagnosis TB paru pada pasien HIV dapat dilakukan berdasarkan pemeriksaan mikrobiologis dan klinis. Rekomendasi WHO 2007, memperbolehkan penegakan diagnosis berdasarkan hasil pemeriksaan klinis dengan dan tanpa melalui pemeriksaan mikrobiologis. Penelitian ini bertujuan mendapatkan perbedaan karakteristik gambaran radiografi toraks pasien HIV dengan TB paru yang didiagnosis berdasarkan pemeriksaan mikrobiologis dan klinis. Metode : Penelitian ini adalah comparative cross sectional study. Subyek penelitian diambil secara consecutive dan dipilih berdasarkan catatan hasil pemeriksaan BTA sputum, kultur, Genexpert®, CD4+, dan radiografi toraks. Subyek penelitian dikelompokkan menjadi mikrobiologis dan klinis. Dilakukan pembacaan ulang radiografi toraks. Hasil : gambaran radiografi toraks dengan frekuensi terbanyak pada kelompok diagnosis mikrobiologis adalah infiltrat/konsolidasi, fibroinfiltrat, limfadenopati, kavitas dan kalsifikasi. Sisanya efusi pleura, milier, fibrosis, bronkiektasis, pneumotoraks dan normal. Pada kelompok diagnosis klinis, gambaran radiografi toraks dengan frekuensi terbanyak adalah infiltrat/konsolidasi, kavitas, limfadenopati, fibroinfiltrat dan sisanya kalsifikasi, efusi pleura, milier, fibrosis, bronkiektasis, dan normal. Terdapat perbedaan bermakna karakteristik gambaran radiografi toraks fibroinfiltrat pada kelompok diagnosis mikrobiologis dan klinis. Frekuensi fibroinfiltrat terbanyak adalah di kelompok mikrobiologis dengan sebaran lokasi tersering di lapangan atas paru. Kesimpulan : Terdapat perbedaan bermakna karakteristik gambaran radiografi toraks fibroinfiltrat pada kelompok diagnosis mikrobiologis dan klinis dengan lokasi tersering di lapangan atas paru.

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Background : To diagnose Pulmonary Tuberculosis in HIV patient can be done based on microbiology examination and clinically. WHO 2007 recommendation, allowing diagnosis based on clinical examination with and without microbiological examination. This study aims to obtain the different characteristics of chest radiographs of HIV patients with pulmonary TB were diagnosed based on clinical and microbiological examination.

Methods : This study is a comparative cross-sectional study. Subjects were taken consecutively and selected based on the results of sputum smear examination, culture, Genexpert®, CD4+, and chest x-ray. The study subjects were grouped into microbiological and clinical. Then we do expertise review.

Results : The most chest x-ray finding in the microbiological group is infiltrates/ consolidation. Following by fibroinfiltrat, lymphadenopathy, cavities and calcification. The rest are pleural effusion, miliary, fibrosis, bronchiectasis, pneumothorax and normal . In the group of clinical diagnosis, the highest frequency chest x-ray finding is infiltrates/ consolidation. Following by cavities, lymphadenopathy, fibroinfiltrat and the rest are calcification, pleural effusion, miliary, fibrosis, bronchiectasis and normal. There is significant differences of fibroinfiltrat on microbiological and clinical diagnosis groups. The highest frequency of fibroinfiltrat is in the microbiological group with the most common sites in the upper of the lung field.

Conclusions : There is significant differences of fibroinfiltrat on microbiological and clinical diagnosis groups with the most common sites in the upper lung field."