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"Pendahuluan. Para penderita HIV diketahui memiliki risiko kanker yang lebih tinggi di banding populasi umum, dan kondisi itu mempengaruhi morbiditas dan mortalitas populasi tersebut. Tujuan dari penelitian ini adalah untuk mendapatkan gambaran prevalensi ADC dan NADC selama 8 tahun terakhir di RSUPN Cipto Mangunkusumo, Jakarta, Indonesia.Metode. Penelitian ini menggunakan 149 sampel yang diambil secara konsekutif. Karakteristik demografis yang dinilai yaitu jenis kelamin, usia, faktor risiko, CD4+, terapi ARV, stadium kanker dan obat ARV yang diberikan.Hasil. Dari seluruh pasien didapatkan Limfoma Non Hodgkin (LNH) sebagai kanker terbanyak, yaitu 45 pasien (30%) dari seluruh kanker dan diikuti kanker serviks sebanyak 30 (20%) pasien. Kanker tipe NADC terbanyak meliputi kanker tipe sarkoma dan kanker hati sebanyak masing masing 10 (6%) dari seluruh kasus. Sebanyak 119 (79,9%) pasien memiliki usia kurang dari 50 tahun dan 82 (55,03%) dalam terapi ARV. CD4+ pada 102 (68,46%) pasien berada dibawah 200 sel/uL dan CD4+ > 350 sel/uL dimiliki oleh 16 (17,45%) pasien.Simpulan. Pada penelitian kami, didapatkan ADC lebih banyak dari NADC (87 vs 62). Peningkatan terapi ARV, skrining kanker dini dan tatalaksana komorbiditas akan membantu peningkatan kualitas hidup dan kesintasan terkait kanker pada pasien HIV.

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Introduction. Patients with HIV are known to possess a higher risk of malignancy compared to the general population. The purpose of this study was to get an overwiew of the prevalence of ADC and NADC over the last 8 years at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

Methods. This study used 149 samples consecutively. Demographic characteristics assessed were sex, age,risk factors, CD4+, ARV therapy, malignancy stadium and ARV consumed.

Results. Of all patients, Non-Hodgkin’s Lymphoma (LNH) was the most common malignancy with 45 patients (30%) of all cancers, followed by cervical cancer with 30 patients (20%). Most common NADC included sarcoma type cancer and liver cancer each with 10 patients (6%) of all cases. One-hundred and nineteen patients (79.9%) were younger than 50 years old and 82 patients (55.03%) were taking ARV therapy. Serum CD4+ count in 102 patients (68.46%) were <200 cells/uL and 16 patients (17.45%) had CD4+ count >350 cells/uL.

Conclusion. In our study, the number for ADC was larger than NADC (87 vs 62). Increasing ARV therapy, early cancer screening and management of comorbidities will help improve the quality of life and cancer-related survival in HIV patients."

"Latar Belakang Human immunodeficiency virus (HIV) merupakan virus yang menyerang sistem imun dengan tahap akhir berupa AIDS (acquired immunodeficiency syndrome). Penyebab kematian pada penderita HIV dapat dikelompokkan menjadi terkait AIDS dan tidak terkait AIDS. Sejak digencarkannya pemberian ARV, beberapa penelitian menunjukkan penurunan tren mortalitas serta perubahan tren penyebab mortalitas menjadi penyakit yang tidak terkait dengan AIDS. Penelitian terbaru diperlukan untuk mengevaluasi penyebab kematian pada pasien HIV rawat inap di RSCM selama periode 2020-2023. Metode Penelitian deskriptif observasional dengan metode kohort retrospektif ini menggunakan data rekam medis rawat inap RSCM periode Juli 2020-Juni 2023. Variabel yang diamati diantaranya adalah luaran, status terapi ARV, dan penyebab kematian. Hasil Dari total 497 pasien yang dianalisis dalam penelitian ini, proporsi mortalitas pasien sebesar 21,1% dengan proporsi tertinggi pada tahun 2020 (25,9%) dan mengalami penurunan hingga tahun 2023. Penyebab mortalitas didominasi oleh penyebab terkait AIDS (76,2%), dengan penyebab terbanyak berupa syok sepsis (20%). Sebanyak 81,6% pasien yang tidak pernah/putus terapi ARV mengalami kematian akibat penyebab terkait AIDS. Kesimpulan Proporsi mortalitas pasien HIV rawat inap RSCM mengalami penurunan dari tahun 2020 hingga 2023. Penyebab mortalitas masih didominasi oleh penyebab terkait AIDS, khususnya pada kelompok tidak pernah/putus terapi.

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Introduction Human Immunodeficiency Virus (HIV) is a virus that attacks the immune system, with the final stage being Acquired Immunodeficiency Syndrome (AIDS). The causes of death in HIV patients can be categorized as AIDS-related and non-AIDS-related. Since the intensification of ARV administration, several studies have indicated a shift in the trend of mortality causes towards non-AIDS related cause of death. New research is needed to evaluate the causes of death in HIV inpatients at RSCM during the period 2020-2023. Method This observational descriptive study with a retrospective cohort design utilizes medical records data of hospitalized patient at RSCM from July 2020 to June 2023. Observed variables include outcomes, ARV therapy status, and causes of death. Results Of the total 495 patients analyzed in this study, the patient mortality rate was 21.1%, with the highest mortality rate in 2020 (25,9%) and continue to decrease until 2023. Mortality causes were predominantly AIDS-related (76,2%), with the most common cause being septic shock (20%). A total of 81,6% of patients who never/discontinued ARV therapy experienced death due to AIDS-related causes. Conclusion The proportion of mortality in HIV inpatients at RSCM has decreased from 2020 to 2023. The causes of mortality are still predominantly AIDS-related, especially in the group with no/interrupted therapy."

"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 : 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."

"Koinfeksi HIV dan tuberkulosis masih merupakan ancaman kesehatan global saat ini. Diperkirakan sebanyak 1.4 juta kasus tuberculosis pada pasien HIV (+) dilaporkan pada tahun 2007. HIV merupakan risiko terbesar untuk tuberculosis, risiko berkembang menjdai TB laten 20 kali lipat. Tuberkulosis penyebab utama kematian pada pasien HIV.Pengobatan tuberculosis paru pada pasien HIV harus dimulai sesegera mungkin saat diagnosis ditegakkan, inisiasi dari pengobatan berkorelasi dengan menurunnya mortalitas dan risiko penularan infeksi tuberculosis. Tujuan dari penelitian ini adalah menilai perubahan radiografi toraks pada pasien HIV dengan tuberculosis selama pemberian obat anti tuberkulosis (OAT) di rumah sakit Cipto Mangunkusumo. Semua pasien yang menjalani pemeriksaan radiografi toraks proyeksi AP atau PA sebelum pengobatan, setelah 2 bulan dan 6 bulan setelah pengobatan diberikan dan juga bulan ke 9 dan 12 apabila pengobatan dilanjutkan. Kemudian perubahan scoring lesi radiografi toraks diamati dan dievaluasi. Hasil penelitian adalah statistic deskriptif menggambarkan perubahan scoring lesi radiogafi toraks sebelum dan 2 bulan serta setelah pengobatan 2 bulan dan 6 bulan setelah terapi diberikan. Perubahn yang terlihat pada radiografi toraks membaik 33 pasien (60%), menetap 9 pasien (16.4%) dan memburuk 13 pasien (23.6%). Perubahan lain pada bulan ke-2 dan ke-6 adalah; membaik 43 pasien (78.2%), menetap 6 pasien (10.9%) dan memburuk 6 pasien (10.9%). Kemungkinan kecurigaan kasus imune reconstitution inflammatory syndrome (IRIS) terdapat pada 3 pasien (5.45%). Perubahan skoring lesi pada bulan ke-2 dan ke-6 dianalisa dengan menggunakan Friedman Rank test dengan nilai confidence interval CI 95% ( p = 0.000). Kesimpulan : Perubahan skoring lesi pada radiografi toraks pasien HIV dengan tuberkulosis paru lebih terlihat membaik setelah 6 bulan sejak diberikan obat anti tuberkulosis. Radiografi toraks masih merupakan modalitas bermakna dalam mengevaluasi perubahan lesi pada pasien HIV dan tuberculosis paru.

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HIV and tuberculosis coinfection are major global health threats recently. It was estimated1.4 milionnew tuberculosis cases in patient with HIV- positive were reported in 2007. HIVconfers the greatest risk for tuberculosis, increasing the risk of latentTB reactivation 20-fold.Tuberculosis is a leading cause of death among patients with HIV.The initiation treatment of lung tuberculosis in HIV patients beginsmust be started as early as possible at the time when diagnose is made, the initiation treatment of tuberculosis correlated with decreasing mortality and risk of transmission tuberculosis infection.

The aim of this research is to observe changes of chest radiography in HIV patients with tuberculosis during administration of anti tuberculous therapy at CiptoMangunkusumo hospital. All of patients have taken chest radiography with PA or AP projection before the treatment begin and after 2 and 6 months therapy was given and also after 9 and 12 months if therapy continued, than the changes scoring lesion of chest radiography finding is observed and examined.

Descriptive statistic is provided as scoring lesion changes of chest radiography devided into changes chest radiography before and 2 month after anti tuberculous therapy was given and changes at 2 months to 6 months therapy was given. In group before and 2 months therapy, the changes was seen in chest radiography; better in 33 patients (60%), stationary condition in 9 patients (16.4%) and worse 13 patients (23.6%). Another changes in 2 and 6 months therapy was seen; better in 43 patients (78.2%), stationary condition in 6 patients (10.9%) and worse 6 patients (10.9%). Imune reconstitution inflammatory syndrome was suspected in 3 patients (5.45%).

The changes of scoring lesion in 2 and 6 months therapy was examined used Friedman Rank test with confidence interval CI 95% ( p = 0.000)."

"HIV merupakan penyakit yang sering terjadi bersamaan dengan penyakit lain. Keberadaan penyakit penyerta memerlukan terapi bersama dengan obat ARV. Hal ini memungkinkan terjadinya interaksi antar obat yang berpotensi menyebabkan penurunan atau peningkatan kadar obat dalam darah, yang bisa menimbulkan kegagalan terapi atau efek samping berupa toksisitas. Penelitian ini bertujuan melihat potensi interaksi yang penting secara klinis dari terapi ARV dengan obat komorbidnya. Penelitian ini adalah penelitian non eksperimental, pengambilan data dilakukan secara potong lintang pada pasien HIV dengan komorbid yang dirawat di rumah sakit Cipto Mangunkusumo dalam periode Januari 2016 sampai dengan Juli 2017. Data diambil dari electronic health record dan pusat rekam medis RSCM. Dari 224 pasien HIV yang masuk kedalam kriteria inklusi, terdapat 121 pasien yang memenuhi persyaratan dan diambil menjadi subjek penelitian. Potensi interaksi yang penting secara klinis didefinisikan sama dengan potensi interaksi mayor memerlukan modifikasi dosis, jangan diberikan bersamaan, kontraindikasi atau hindari . Hasil penelitian menunjukkan dari 121 pasien, potensi interaksi mayor terjadi pada 18 pasien 14,99 dengan potensi interaksi yang menurunkan kadar ARV pada 14 pasien 11,57 . Kejadian potensi interaksi mayor yang paling banyak terjadi yaitu antara nevirapin dan rifampisin 3,53 . Komorbid terbanyak adalah Tuberkulosis Paru 12,92 . Diperlukan penelitian prospektif pengukuran kadar obat dan efek terapi akibat interaksi obat ARV dengan obat komorbidnya.

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HIV is a disease commonly presents with other comorbidities which need concomitant treatments with ARV. Drug-drug interaction is an unavoidable consequence which may potentially lead to an increase or a decrease of affected drug and ultimately resulted in therapeutic failure or otherwise, toxicity.This study was aimed to look at the potential of clinically significant drug-drug interactions between ARV and other treatments. This was a non experimental cross sectional study conducted on HIV patients with comorbids treated at the Cipto Mangunkusumo hospital from January 2016 to Juli 2017. Data were taken from the electronic health record and Cipto Mangunkusumo hospital medical record. From 224 HIV patients who meet the criteria of inclusion, there are 121 patients that rsquo;s fulfilled the conditions and was taken to be the subjects of research. The potential of clinically significant drug-drug interactions are definitioned as potential for major interaction requiring dose modification, do not coadminister, contraindicated or avoid . The results showed that potential for mayor interactions occurred in 18 out of 121 patients 14.99 . Potential decrease of blood ARV level was found in 14 patients 11.57 . The occurance of potential for major interaction mostly happened between nevirapin and rifampisin 3,35 . The most comorbid is pneumonia tuberculosis 12.92 . Prospective study is required to measure drugs level and the effect of therapy consequence ARV drugs interaction with comorbid drugs"

"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.

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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."

"Cryprosporidium sp adalah parasit yang merupakan protozoa penyebab diare pada individu lmunodefisiensi seperti penderita HlV/AIDS, Diagnosis criptosporidiosis dengan menemukan ookista pada tinja menggunakan metode pulasan tahan asam dinilai kurang sensitif. Deteksi koproantigen Crypto:,poridium sp menggunakan ELISA diketahui lebih sensitif dan spesifik. Penelitian ini bertujuan untuk deteksi koproantigen Cryptosporidlum sp pada pasien HIV/AJDS dengan diare kronik menggunakan ELISA dan MTA serta melihat korelasi antara nilai absorbansi dengan hitung ookista. Sebanyak 95 sampel tinja dari pasien HIV/AIDS dengan diare kronik diperiksa menggunakan pulasan tahan asam yang merupakan gold standort dan deteksi koproantigen. Frekuensi kriptosporidiosis menggunakan deteksi koproantigen sebesar 36,8% dan dengan metode MTA 11,6%. Nilai sensitivitas dan spesifisitas koproantigen dibandingkan dengan pulasan tahan asam sebesar 100% dan 71A%. Tidak terdapat korelasi antara nilai absorbansi dengan hitung ookista.

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Cryptosporidium sp is a protozoan parasite, causes severe diarrhea in immunodeficient hosts like the HIV/AIDS patients. Diagnosis of cryptosporidiosis by finding the oocyst from stool by modified acid fast staining, is insensitive. Coproantigen detection offers more sensitive and specific technique to detect Cryptosporidium infection. The objective of this study is to determine cryptosporidiosis proportion among HIVIAIDS patients by Cryptosporidial antigen detection in stool compare it to modified acid fast staining and determine its correlation with oocyts count. A number of 95 stool specimens from the HIV/AIDS patients with chronic diarrhea were subjected to coproantigen ELISA test and modified acid-fast staining (gold standard). The frequency of Criptosporidial infection was 36,8% and 11,6% respectively by coproantigen detection and AF staining with 100% sensitivity and 71.4% specificity. There is no correlation between optical density and oocyst count."