Samsuridjal Djauzi
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta

Published : 13 Documents
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Highly active antiretroviral therapy adherence and its determinants in selected regions in Indonesia Widjaja, Felix F.; Puspita, Caroline G.; Daud, Ferdi; Yudhistrie, Ienag; Tiara, Marita R.; Suwita, Christopher S.; Zain, Ekachaeryanti; Husna, Lailatul; Djauzi, Samsuridjal
Medical Journal of Indonesia Vol 20, No 1 (2011): February
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (101.509 KB) | DOI: 10.13181/mji.v20i1.429

Abstract

Background: Highly active antiretroviral therapy (HAART) can reduce morbidity and mortality of HIV-infected patients. However, it depends upon adherence to medication. The objective of this study was to examine the adherence to HAART and to evaluate individual patient characteristics i.e. self-efficacy, depression level, and social support and to finally determine HAART adherence in selected regions in Indonesia.Methods: This cross-sectional study was conducted in Jakarta, Malang, Bandung, Makasar and Banda Aceh. The subject of the study was HIV-infected patients who were older than 13 years old and had taken HAART for at least a month. They were recruited consecutively then asked how many pills they had missed during the previous month. Poor adherence can be stated if the percentage of adherence rate is below 95%. HIV treatment adherence self-efficacy scale  (HIVASES), Beck Depression Inventory (BDI-II) and Interpersonal Support Evaluation List (ISEL) was adapted to assess self-efficacy, depression level and social support, respectively.Results: We found that 96% (n=53) of the subjects adhered to HAART. There were no associations between adherence with self-efficacy, depression level, and social support. The main cause of non-adherence in this study was ‘simply  forget’.Conclusion: Adherence to HAART was found to be high and not associated with self-efficacy, depression level and social support in some central regions in Indonesia. (Med J Indones 2011; 20:50-5)Keywords: adherence, depression, HAART, HIV, self-efficacy, social support
Development of multiplex-PCR assay for rapid detection of Candida spp. Tarini, Ni Made A.; Wahid, Mardiastuti H.; Ibrahim, Fera; Yasmon, Andi; Djauzi, Samsuridjal
Medical Journal of Indonesia Vol 19, No 2 (2010): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (108.411 KB) | DOI: 10.13181/mji.v19i2.387

Abstract

Aim Candida spp. infection commonly occur in immunocompromised patients. Biochemical assay for identification of Candida spp. is time-consuming and shows many undetermined results. Specific detection for antibody, antigen and metabolites of Candida spp. had low sensitivity and specificity. In this study, we developed a rapid diagnostic method, Multiplex-PCR, to identify Candida spp.Methods Five Candida spp. isolates were cultured, identifi ed with germ tube and API® 20 C AUX (BioMerieux® SA) kit. Furthermore, DNA was purified by QIAamp DNA mini (Qiagen®) kit for Multiplex-PCR assay.Results DNA detection limit by Multiplex-PCR assays for C. albicans, C. tropicalis, C. parapsilosis, C. krusei and C. glabrata were 4 pg, 0.98 pg, 0.98 pg, 0.5 pg and 16 pg respectively. This assay was also more sensitive than culture in that Multiplex-PCR could detect 2.6-2.9 x 100 CFU/ml, whereas culture 2.6-2.9 x 102 CFU/ml.Conclusion Multiplex-PCR is much more sensitive than culture and thus, can be recommended as a sensitive and specific assay for identification of Candida spp. (Med J Indones 2010; 19:83-7)Keywords: Candida spp., multiplex-PCR
Interleukin-18 levels in adult dengue fever and dengue hemorrhagic fever Pohan, Herdiman T.; Suhendro, Suhendro; Bur, Rika; Matondang, Asnath; Djauzi, Samsuridjal; Inada, Katsuya; Endo, Shigeatsu
Medical Journal of Indonesia Vol 13, No 2 (2004): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (271.037 KB) | DOI: 10.13181/mji.v13i2.136

Abstract

Interleukin (IL)-18 ( interferon-γ inducing factor) is one of cytokines, produced by macrophage, take part in differentiation T-helper (Th) to Th1 and interferon γ producing. T helper1 play role in cellular immunity especially in viral infection include dengue. A descriptive correlative study has done to know the correlation between IL-18 levels and disease severity in admitted dengue fever (DF) and dengue hemorrhagic fever (DHF) patients. In 42 subjects consist of 20 (47.6%) DF and 22 (53.3%) DHF (grade I to IV WHO criteria, 1999) showed that IL-18 levels significantly higher in DHF than DF patients. There are significant correlation between IL-18 levels and hematocrit and low platelet value. This study supports the possible role of IL-18 in pathogenesis DHF in adults. (Med J Indones 2004; 13: 86-9)Keywords: dengue, dengue hemorrhagic fever, IL-18, cytokine, pathogenesis
Sunlight–derived vitamin D affects interleukin-4 level, T helper 2 serum cytokines, in patients with Graves’ disease: a prospective cohort study Purnamasari, Dyah; Soewondo, Pradana; Djauzi, Samsuridjal
Medical Journal of Indonesia Vol 24, No 4 (2015): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (394.046 KB) | DOI: 10.13181/mji.v24i4.1270

Abstract

Background: Graves’ disease (GD) is the most common autoimmune disease leading to hyperthyroidism. The role of Th1/Th2 pathways balance in GD is still controversial. Vitamin D is reported to have an effect on those pathways. This study aims to examine the effect of sunlight exposure on vitamin D 25(OH) level and Th1 and Th2 pathway-derived cytokines in GD patients. Methods: A prospective cohort study was conducted on 32 GD patients to compare the effect of sunlight exposure on vitamin D level and cytokines of Th1 and Th2 pathways between exposed and unexposed groups. Exposed group received sunlight exposure three times a week for 30 minutes each between 9–11 a.m for 1 month. Thyroid stimulating hormone (TSH), free thyroxin (fT4), vitamin D 25(OH), interferon-γ (IFN-γ) and interleukin-4 (IL-4) serum levels, were investigated before and after one month of sunlight exposure. Paired t-test or Mann Whitney test were used to analyze the difference between exposed and unexposed GD groups before and after sun exposure.Results: One month of sunlight exposure increased vitamin D 25(OH) level by 27.90% among exposed GD group (15.34 ng/mL to 19.62 ng/mL, p<0.001). Meanwhile, unexposed GD group’s vitamin D 25(OH) level decreased from 20.48 ng/mL to 18.86 ng/mL (p<0.001). Increased vitamin D 25(OH) level in exposed group was not accompanied by the increase of IL-4 level after sunlight exposure.Conclusion: Sunlight exposure increases vitamin D 25(OH) serum level and may affect the level of IL-4, Th2 pathway-derived cytokine, in patients with GD. However, the role of sunlight-derived vitamin D on IFN-γ in GD patients can not be concluded in this study.
Family support is not a risk factor of negative self-esteem in HIV/AIDS women Valeria, Jean; Surilena, Surilena; Budiman, Yanto; Djauzi, Samsuridjal; Indah, Haridana
Universa Medicina Vol 34, No 1 (2015)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2015.v34.61-67

Abstract

BACKGROUND Women with HIV/AIDS (WLWHA) have a complex psychosocial burden and a tendency to negative self-esteem, possibly resulting in mental and emotional problems. They need family support to deal with the HIV/AIDS infection and its psychosocial burden. The purpose of this study was to determine chacteristics of family support, self-esteem, and depression of WLWHA and the relationship between family support and self-esteem and depression. METHOD This was a cross-sectional study of 99 WLWHA infected through their husbands/partners, with no history of drug abuse. The data was taken by a consecutive sampling of two proportions test at Dharmais Cancer Hospital from November 2013 – January 2014. The instruments comprised a demographic questionnaire, the Rosenberg Self-Esteem questionnaire, the Hamilton Depression Rating Scale (HDRS), and a family support questionnaire. The data was analyzed by binary logistic regression. RESULTS There were 99 respondents with mean age of 36 years, of whom 44.4% were high school graduates, 54.5% unemployed, and 91.9% had HIV/ AIDS for more than a year. Binary logistic regression analysis showed no significant relationship between family support and self-esteem (p=0.700) and depression (p=0.396). Good family support has a protective effect of 1.3 times (OR=0.772; 95%CI: 0.138-3.770) towards increasing self-esteem, whereas poor family support increases the risk of depression 1.5 times (OR=1.477; 95%CI: 0.598-3.645) in WLWHA infected with HIV/AIDS from their husband/partner. CONCLUSIONS Good family support tend to have a protective effect towards increasing self-esteem, whereas poor family support increases the risk of depression in WLWHA infected with HIV/AIDS from their husband/partner.
Faktor-Faktor yang Berhubungan dengan Retention in Care Satu Tahun Pasca Persalinan pada Pasien yang Menjalani Pencegahan Penularan HIV dari Ibu ke Anak di RSCM Yulidar, Yulidar; Yunihastuti, Evy; Djauzi, Samsuridjal; Padmita, Astrid Citra; Koesnoe, Sukamto
Jurnal Penyakit Dalam Indonesia Vol 4, No 2 (2017)
Publisher : Jurnal Penyakit Dalam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Pendahuluan. Retention in care telah terbukti penting untuk mencapai keberhasilan pengobatan HIV. Namun, data mengenai retention in care khusus pada ibu hamil di Indonesia hingga saat ini belum tersedia. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan retention in care satu tahun pasca persalinan pada ibu yang menjalani Program Pencegahan Penularan HIV dari Ibu ke Anak (PPIA) di Unit Pelayanan Terpadu HIV Rumah Sakit dr. Cipto Mangunkusumo (UPT HIV RSCM).Metode. Studi kohort retrospektif dilakukan pada 265 pasien HIV pasca melahirkan yang mendapat PPIA dan berobat jalan di UPT HIV RSCM dalam kurun waktu Januari 2004-Mei 2014. Penilaian retention in care satu tahun pasca PPIA dilakukan dengan melihat rekam medik. Data yang dikumpulkan berupa usia, kadar CD4 awal, toksisitas obat, pasien pengguna narkoba suntik (penasun/injecting drug user/IDU), lama mendapatkan Antiretroviral (ARV) sebelum melahirkan, memiliki anak dengan status HIV positif, memiliki pasangan dengan status HIV positif, jarak rumah pasien ke RSCM, dan indikasi ARV. Dilakukan analisis bivariat dengan uji Chi Square dan Mann Whitney, dan analisis multivariat dengan regresi logistik untuk menilai faktor yang berhubungan dengan retention in care pasca PPIA.Hasil. Sebanyak 253 subjek diikutsertakan pada penelitian ini. Didapatkan angka retention in care satu tahun pasca persalinan sebesar 55,3%. Dari analisis multivariat, didapatkan faktor-faktor yang berhubungan dengan retention in care satu tahun pasca persalinan dengan kekuatan hubungan mulai dari yang paling besar hingga terkecil adalah indikasi ARV untuk terapi (OR= 3,812[IK 95%:1,825-7,966]), bukan penasun (OR=3,055 [IK 95%:1,382-6,752]), lama mendapat ARV sebelum melahirkan >6 bulan (OR= 2,657[IK 95%:1,328-5,316]), dan kadar CD4 awal <200 (OR= 2,033 [IK 95%:1,061-3,894]).Simpulan. Faktor yang memengaruhi retention in care satu tahun pasca persalinan adalah indikasi ARV untuk terapi, lama mendapat ARV sebelum melahirkan > 6 bulan, bukan penasun, dan kadar CD4 < 200 /mm3. Kata Kunci: HIV, pasca persalinan, PPIA, retention in care  Factors Associated with Retention in Care One Year after Delivery in Patients Undergoing Prevention of Mother to Child Transmission (PMTCT) at RSCMIntroduction. Retention in care is important to the successful of HIV treatment. This study is aimed to analyze factors associated with retention in care one year after delivery in patients undergoing PMTCT at HIV integrated clinic of RSCM. Methods. A retrospective cohort study was conducted among post-partum HIV patients who were given ARV therapy for PMTCT at HIV intergrated clinic of Cipto Mangunkusumo Hospital from January 2004 to May 2014. Evaluation of one year retention in care after PMTCT was performed by observing medical records of the patient. The collected data were factors associated with one year after delivery retention in care including age of patients, level of initial CD4, ARV toxicity, injecting drug user, duration of ARV before delivery, having child with positive HIV status, having spouse with positive HIV status, distance from the residence to the hospital, and indication of ARV. Bivariate analysis was performed by using Chi Square and Mann Whitney test and multivariate anaysis was performed by using logistic regression to assess factors associated with retention in car after PMTCT program. Results. 253 subjects met the inclusion criteria. In One year after delivery, the retention in care rate was 55,3%. Multivariate analysis found that factors significantly associated with one year retention in care were indication of ARV initiation for therapy (OR =3,812 [95% CI: 1,825-7,966]), non-IDU patients (OR=3,055 [95% CI: 1,382-6,752]), duration of ARV before delivery for more than 6 months (OR = 2,657 [95% CI: 1,328-5,316]), and level of initial CD4 less than 200/mm3 (OR = 2,033 [95% CI: 1,061-3,894]). Conclusions. Factors significantly associated with one year after delivery retention in care are indication of ARV for therapy, duration of ARV before delivery, non-IDU patients, and level of initial CD4 less than 200/mm3. 
Faktor Prediktor Kegagalan Virologis pada Pasien HIV yang Mendapat Terapi ARV Lini Pertama dengan Kepatuhan Berobat Baik Kurniawan, Farid; Djauzi, Samsuridjal; Yunihastuti, Evy; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol 4, No 1 (2017)
Publisher : Jurnal Penyakit Dalam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Pendahuluan. Pada negara dengan keterbatasan sumber daya, pengukuran viral load (VL) sebagai prediktor efektivitas terapi antiretroviral (ARV) tidak selalu mudah untuk diakses oleh pasien HIV yang mendapat terapi ARV. Pada penelitian-penelitian sebelumnya, kepatuhan berobat (adherens) diketahui merupakan faktor penting terhadap supresi VL HIV. Penelitian ini bertujuan untuk mengetahui faktor prediktor kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama sesuai paduan ARV terbaru dengan kepatuhan berobat yang baik di Indonesia.Metode. Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan dewasa di Rumah Sakit dr. Cipto Mangunkusumo (RSCM), Jakarta yang memulai terapi ARV lini pertama selama periode Januari 2011-Juni 2014. Pasien HIV dengan kepatuhan berobat baik yang mempunyai data VL 6-9 bulan setelah mulai terapi ARV dimasukkan sebagai subjek penelitian. Kegagalan virologis dinyatakan sebagai nilai VL ≥400 kopi/mL setelah minimal 6 bulan terapi ARV dengan kepatuhan berobat baik. Usia awal terapi ARV, faktor risiko penularan HIV, stadium klinis HIV menurut World Health Organization (WHO), koinfeksi HIV-TB, jumlah CD4 awal terapi, peningkatan jumlah CD4, kadar hemoglobin dan indeks massa tubuh awal terapi, perubahan berat badan selama terapi, dan basis paduan terapi ARV merupakan variabel yang diteliti pada penelitian ini.  Hasil. Terdapat 197 pasien sebagai subjek penelitian ini. Kegagalan virologis ditemukan pada 21 pasien (10,7%). Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi merupakan prediktor kegagalan virologis (p = 0,003; OR 5,802, 95% CI= 1,842-18,270). Terdapat peningkatan risiko kegagalan virologis pada pasien dengan terapi ARV berbasis NVP pada saat VL diperiksa, namun tidak bermakna secara statistik (p = 0,060; OR 2,756; 95% CI= 0,958-7,924). Simpulan. Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi dapat memprediksi kegagalan virologis pada pasien yang mendapat terapi ARV lini pertama dengan kepatuhan berobat yang baik. Kata Kunci: kegagalan virologis, terapi ARV lini pertama, viral load Predictors of Virological Failure in HIV Patients Receiving First Line Antiretroviral Therapy with Good AdherenceIntroduction. Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate success or failure of ART. However, in country with limited resources, viral load measurement is not easily accessible by HIV patients receiving ART. Therefore, it is necessary to know which factors that can predict virological failure. In previous studies, adherence was an  important factor for suppression of HIV viral load.  This study is aimed to know predictors of virological failure in HIV patients receiving recent first line ART regimen with good adherence in Indonesia. Methods. A retrospective cohort study was conducted among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo Hospital that started ART during periode of  January 2011-June 2014. HIV patients with good adherence that had viral load data 6-9 months after initiation of ART were included in this study. Virological failure was defined as viral load ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. Age at starting ART, risk factor for HIV infection, HIV clinical stage, HIV-TB co-infection, baseline CD4 value, CD4 count increase, baseline hemoglobin level and body mass index, weight changes during therapy, and ART based regimen were analyzed in this study. Results. A total of 197 patients were included in this study. Virological failure was found in 21 patients (10,7%). CD4 increase <50 cell/mm3 after minimum 6 months of ART was predictor of virological failure (p = 0,003; OR 5,802, 95%CI 1,842-18,270). Conclusion. CD4 increase <50 cell/mm3 after minimum 6 months therapy can predict virological failure in HIV patients receiving first line ART with good adherence.  
Correlation between saliva IgA level and T cell CD4+ in HIV/AIDS patients Sufiawati, Irna; Sasanti, Harum; Djauzi, Samsuridjal
Padjadjaran Journal of Dentistry Vol 19, No 2 (2007): July
Publisher : Faculty of Dentistry Universitas Padjadjaran, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (322.211 KB) | DOI: 10.24198/pjd.vol19no2.14169

Abstract

Background: HIV infection appears to have direct effects on oral mucosal immunity, cellular and humoral. Antibody secretion, especially salivary immunoglobulin A (IgA), is a useful indicator of mucosal immune function. This immune system component is recognized as an important first-line of defence against pathogens which colonize and invade mucosal surfaces in the oral cavity. Objectives: The purpose of this study was to investigate salivary IgA levels and to determine its correlation with CD4+ T-cell counts among HIV-infected patients in Pokdisus AIDS Cipto Mangunkusomo Hospital Jakarta. Methods: The design study was using a cross-sectional study. Whole paraffin-wax-stimulated saliva was collected from 103 HIV-infected patients and 30 healthy individuals. Saliva was collected using the spitting method. Salivary IgA levels were determined by the immunoturbidimetry method using the Behring Turbitimer Analyser. CD4+ T-cell counts were analyzed by flow cytometry. Results: Salivary IgA levels were 141.55 ± 83.23 (HIV group) and 97.24 ± 38.25 (healthy individuals). The Mann-Whitney U test showed salivary IgA levels were significantly higher in HIV/AIDS subjects compared with healthy individuals (p<0.1). Most of the subject has severe immunosuppression with CD4+ T-cell counts <200 cell/mm.3 Pearson’s correlation test between CD4+ T-cell counts and salivary IgA levels showed no significant correlation (r= 0.06, p>0.1). Conclusion: This study indicates that total salivary IgA levels were significantly higher in the HIV-infected patients compared to control, and salivary IgA level seems not to be related significantly to CD4+ T-cell counts.
Faktor-Faktor yang Berhubungan dengan Retention in Care Satu Tahun Pasca Persalinan pada Pasien yang Menjalani Pencegahan Penularan HIV dari Ibu ke Anak di RSCM Yulidar, Yulidar; Yunihastuti, Evy; Djauzi, Samsuridjal; Padmita, Astrid Citra; Koesnoe, Sukamto
Jurnal Penyakit Dalam Indonesia Vol 4, No 2 (2017)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1155.834 KB) | DOI: 10.7454/jpdi.v4i2.121

Abstract

Pendahuluan. Retention in care telah terbukti penting untuk mencapai keberhasilan pengobatan HIV. Namun, data mengenai retention in care khusus pada ibu hamil di Indonesia hingga saat ini belum tersedia. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan retention in care satu tahun pasca persalinan pada ibu yang menjalani Program Pencegahan Penularan HIV dari Ibu ke Anak (PPIA) di Unit Pelayanan Terpadu HIV Rumah Sakit dr. Cipto Mangunkusumo (UPT HIV RSCM).Metode. Studi kohort retrospektif dilakukan pada 265 pasien HIV pasca melahirkan yang mendapat PPIA dan berobat jalan di UPT HIV RSCM dalam kurun waktu Januari 2004-Mei 2014. Penilaian retention in care satu tahun pasca PPIA dilakukan dengan melihat rekam medik. Data yang dikumpulkan berupa usia, kadar CD4 awal, toksisitas obat, pasien pengguna narkoba suntik (penasun/injecting drug user/IDU), lama mendapatkan Antiretroviral (ARV) sebelum melahirkan, memiliki anak dengan status HIV positif, memiliki pasangan dengan status HIV positif, jarak rumah pasien ke RSCM, dan indikasi ARV. Dilakukan analisis bivariat dengan uji Chi Square dan Mann Whitney, dan analisis multivariat dengan regresi logistik untuk menilai faktor yang berhubungan dengan retention in care pasca PPIA.Hasil. Sebanyak 253 subjek diikutsertakan pada penelitian ini. Didapatkan angka retention in care satu tahun pasca persalinan sebesar 55,3%. Dari analisis multivariat, didapatkan faktor-faktor yang berhubungan dengan retention in care satu tahun pasca persalinan dengan kekuatan hubungan mulai dari yang paling besar hingga terkecil adalah indikasi ARV untuk terapi (OR= 3,812[IK 95%:1,825-7,966]), bukan penasun (OR=3,055 [IK 95%:1,382-6,752]), lama mendapat ARV sebelum melahirkan >6 bulan (OR= 2,657[IK 95%:1,328-5,316]), dan kadar CD4 awal <200 (OR= 2,033 [IK 95%:1,061-3,894]).Simpulan. Faktor yang memengaruhi retention in care satu tahun pasca persalinan adalah indikasi ARV untuk terapi, lama mendapat ARV sebelum melahirkan > 6 bulan, bukan penasun, dan kadar CD4 < 200 /mm3. Kata Kunci: HIV, pasca persalinan, PPIA, retention in care  Factors Associated with Retention in Care One Year after Delivery in Patients Undergoing Prevention of Mother to Child Transmission (PMTCT) at RSCMIntroduction. Retention in care is important to the successful of HIV treatment. This study is aimed to analyze factors associated with retention in care one year after delivery in patients undergoing PMTCT at HIV integrated clinic of RSCM. Methods. A retrospective cohort study was conducted among post-partum HIV patients who were given ARV therapy for PMTCT at HIV intergrated clinic of Cipto Mangunkusumo Hospital from January 2004 to May 2014. Evaluation of one year retention in care after PMTCT was performed by observing medical records of the patient. The collected data were factors associated with one year after delivery retention in care including age of patients, level of initial CD4, ARV toxicity, injecting drug user, duration of ARV before delivery, having child with positive HIV status, having spouse with positive HIV status, distance from the residence to the hospital, and indication of ARV. Bivariate analysis was performed by using Chi Square and Mann Whitney test and multivariate anaysis was performed by using logistic regression to assess factors associated with retention in car after PMTCT program. Results. 253 subjects met the inclusion criteria. In One year after delivery, the retention in care rate was 55,3%. Multivariate analysis found that factors significantly associated with one year retention in care were indication of ARV initiation for therapy (OR =3,812 [95% CI: 1,825-7,966]), non-IDU patients (OR=3,055 [95% CI: 1,382-6,752]), duration of ARV before delivery for more than 6 months (OR = 2,657 [95% CI: 1,328-5,316]), and level of initial CD4 less than 200/mm3 (OR = 2,033 [95% CI: 1,061-3,894]). Conclusions. Factors significantly associated with one year after delivery retention in care are indication of ARV for therapy, duration of ARV before delivery, non-IDU patients, and level of initial CD4 less than 200/mm3. 
Faktor Prediktor Kegagalan Virologis pada Pasien HIV yang Mendapat Terapi ARV Lini Pertama dengan Kepatuhan Berobat Baik Kurniawan, Farid; Djauzi, Samsuridjal; Yunihastuti, Evy; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia Vol 4, No 1 (2017)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1299.814 KB) | DOI: 10.7454/jpdi.v4i1.110

Abstract

Pendahuluan. Pada negara dengan keterbatasan sumber daya, pengukuran viral load (VL) sebagai prediktor efektivitas terapi antiretroviral (ARV) tidak selalu mudah untuk diakses oleh pasien HIV yang mendapat terapi ARV. Pada penelitian-penelitian sebelumnya, kepatuhan berobat (adherens) diketahui merupakan faktor penting terhadap supresi VL HIV. Penelitian ini bertujuan untuk mengetahui faktor prediktor kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama sesuai paduan ARV terbaru dengan kepatuhan berobat yang baik di Indonesia.Metode. Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan dewasa di Rumah Sakit dr. Cipto Mangunkusumo (RSCM), Jakarta yang memulai terapi ARV lini pertama selama periode Januari 2011-Juni 2014. Pasien HIV dengan kepatuhan berobat baik yang mempunyai data VL 6-9 bulan setelah mulai terapi ARV dimasukkan sebagai subjek penelitian. Kegagalan virologis dinyatakan sebagai nilai VL ≥400 kopi/mL setelah minimal 6 bulan terapi ARV dengan kepatuhan berobat baik. Usia awal terapi ARV, faktor risiko penularan HIV, stadium klinis HIV menurut World Health Organization (WHO), koinfeksi HIV-TB, jumlah CD4 awal terapi, peningkatan jumlah CD4, kadar hemoglobin dan indeks massa tubuh awal terapi, perubahan berat badan selama terapi, dan basis paduan terapi ARV merupakan variabel yang diteliti pada penelitian ini.  Hasil. Terdapat 197 pasien sebagai subjek penelitian ini. Kegagalan virologis ditemukan pada 21 pasien (10,7%). Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi merupakan prediktor kegagalan virologis (p = 0,003; OR 5,802, 95% CI= 1,842-18,270). Terdapat peningkatan risiko kegagalan virologis pada pasien dengan terapi ARV berbasis NVP pada saat VL diperiksa, namun tidak bermakna secara statistik (p = 0,060; OR 2,756; 95% CI= 0,958-7,924). Simpulan. Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi dapat memprediksi kegagalan virologis pada pasien yang mendapat terapi ARV lini pertama dengan kepatuhan berobat yang baik. Kata Kunci: kegagalan virologis, terapi ARV lini pertama, viral load Predictors of Virological Failure in HIV Patients Receiving First Line Antiretroviral Therapy with Good AdherenceIntroduction. Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate success or failure of ART. However, in country with limited resources, viral load measurement is not easily accessible by HIV patients receiving ART. Therefore, it is necessary to know which factors that can predict virological failure. In previous studies, adherence was an  important factor for suppression of HIV viral load.  This study is aimed to know predictors of virological failure in HIV patients receiving recent first line ART regimen with good adherence in Indonesia. Methods. A retrospective cohort study was conducted among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo Hospital that started ART during periode of  January 2011-June 2014. HIV patients with good adherence that had viral load data 6-9 months after initiation of ART were included in this study. Virological failure was defined as viral load ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. Age at starting ART, risk factor for HIV infection, HIV clinical stage, HIV-TB co-infection, baseline CD4 value, CD4 count increase, baseline hemoglobin level and body mass index, weight changes during therapy, and ART based regimen were analyzed in this study. Results. A total of 197 patients were included in this study. Virological failure was found in 21 patients (10,7%). CD4 increase <50 cell/mm3 after minimum 6 months of ART was predictor of virological failure (p = 0,003; OR 5,802, 95%CI 1,842-18,270). Conclusion. CD4 increase <50 cell/mm3 after minimum 6 months therapy can predict virological failure in HIV patients receiving first line ART with good adherence.