Gambaran Kegagalan Perbaikan CD4 Pasien Koinfeksi TB-HIV Berdasarkan Jarak Waktu Pemberian Antiretroviral Pasca Obat Anti Tuberkulosis di Rumah Sakit Penyakit Infeksi (RSPI) Prof. Dr. Sulianti Saroso
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Latarbelakang : Memulai terapi Antiretroviral (ARV) lebih awal berisiko menimbulkan interaksi Obat Anti TB (OAT) dengan ARV, efek samping obat, keracunan akibat obat, tantangan kepatuhan minum obat dan terjadinya Immune Reconstitution Inflammatory Syndrome (IRIS).
Metode : Penelitian ini menggunakan design penelitian kohort restrospektif dengan follow-up selama satu setengah tahun. Penelitian dilaksanakan di Rumah Sakit Penyakit Infeksi (RSPI) Prof. Dr. Sulianti Saroso Tahun 2016. Populasi studi adalah pasien Ko-infeksi TB-HIV yang naive ART dan tercatat pada rekam medis periode Januari 2010 - November 2014. Data pasien diperoleh dari rekam medis pasien dengan kriteria inklusi sampel adalah pasien usia ≥15 tahun, mendapat OAT minimal 2 minggu sebelum ART dimulai, dan memiliki data hasil pemeriksaan CD4 sebanyak dua kali dengan total sampel sebanyak 164 orang.
Hasil : Probabilias kumulatif kegagalan perbaikan CD4 pasien ko-infeksi TB-HIV sebesar 14,43%. Hazard rate kegagalan perbaikan CD4 pada pasien yang memulai terapi ARV 2-8 minggu setelah OAT dibandingkan dengan yang menunda terapi ARV 8 minggu setelah OAT masing-masing 767 per 10.000 orang tahun dan 447 per 10.000 orang tahun (p=0,266).
Kesimpulan : Hazard rate kegagalan perbaikan CD4 pada pasien yang memulai terapi ARV 2-8 minggu setelah OAT lebih tinggi dibandingkan dengan hazard rate pada pasien yang menunda terapi ARV 8 minggu setelah OAT.
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Abstract
Background : Starting Antiretroviral Treatment (ART) earlier was assosiated to pharmacologic interactions, side effect, high pill burden, treatment interruption, and Immune Reconstitution Inflammatory Syndrome (IRIS).
Methods : This study used cohort restrospective design with one and half year time to follow up. This study was conducted from May to June 2016 at Infectious Disease Hospital Sulianti Saroso. Study population were TB-HIV coinfected patients, noted as a naive ART patient in medical records from january
2010-november 2014. A total 164 patients ≥ 15 years old, had ATT 2 weeks before ART and had minimum 2 CD4 sell count laboratorium test results.
Result : The cumulative probability of CD4 response failure among TB-HIV co-infected patients was 14,43%. Hazard rate of CD4 response failure was 767 per 10.000 person year in early ART (2-8 weeks after OAT) versus 474 per 10.000 person year in delayed ART (8 weeks after OAT) (p=0,266).
Conclusion : Hazard CD4 repair failure rate in patients who started ARV therapy 2-8 weeks after OAT higher than the hazard rate in patients who deferred antiretroviral therapy 8 weeks after OAT.
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