Gambaran Hasil Terapi TB Paru pada Pasien TB-HIV di RSUP Dr.Hasan Sadikin Bandung Tahun 2012-2014

Tuberkulosis (TB) merupakan penyakit infeksi oportunistik yang sering dijumpai pada pasien Human Immunodeficiency Virus (HIV). Berkaitan dengan tingginya kejadian TB pada penderita HIV World HealthOrganization (WHO) mencanangkan program penanggulangan TB-HIV. Penelitian ini bertujuan untukmengetahui hasil terapi TB Paru pada pasien TB-HIV yang dirawat inap dan rawat jalan di RSUP dr.HasanSadikin. Penelitian deskriptif kuantitatif ini menggunakan sumber data dari rekam medis pasien TB-HIV diinstalasi rawat inap dan rawat jalan RSUP dr.Hasan Sadikin Bandung Tahun 2012-2014. Karakteristik sosiodemografi meliputi usia, jenis kelamin, pendidikan, pekerjaan, status pernikahan, dan tempat tinggal.  Terdapat60 (84,5%) subjek yang berusia 20-40 tahun, laki-laki 50 (70,4%) subjek, lebih banyak dari perempuan.Subjek dengan pendidikan SMA sebanyak 33 (46,4%) orang dan subjek yang tidak bekerja 20 (71,8%) orang,47 (66,2%) subjek sudah menikah dan subjek yang berdomisili di Bandung 56 (78,9%) orang. Luaran terapipada pasien ko-infeksi TB-HIV yang sembuh berjumlah 17 (23,9%) subjek, sembuh lengkap 14 (19,7%)subjek, putus pengobatan 24 (33,8%) subjek, pindah sebanyak 8 (11,3%) subjek, dan meninggal 8 (11,3%)subjek dan tidak terdapat luaran terapi gagal. Hasil luaran terapi TB paru pada pasien ko-infeksi TB-HIVdi instalasi rawat inap dan rawat jalan di RSUP dr.Hasan Sadikin yang banyak adalah putus pengobatandibandingkan dengan luaran terapi sembuh

Improving Diagnostic of Pulmonary Tuberculosis in HIV Patients by Bronchoscopy: A Cross Sectional Study

Background: diagnostic of pulmonary TB in HIV patients is a problem due to non specific clinical features, or radiological appearance. HIV patients with CD4≤200 cells/mL infected with M. tuberculosis have less capacity in containing M. tuberculosis, developing granulomas, casseous necrosis, or cavities. This condition is caused by weakend inflammatory which later reduced sputum production and may cause false negative result. This study aimed to assess differences in the positivity level of acid fast bacilli (AFB) and cultures of M. tuberculosis from non-bronchoscopic sputum (spontaneous and induced sputum) compared to bronchoscopic sputum (bronchoalveolar lavage) in HIV positive patients suspected pulmonary tuberculosis with CD4<200 cells/μL.Methods: this cross sectional study was conducted in adult HIV patients treated in Hasan Sadikin Hospital with CD4≤200 cells/μL suspected with pulmonary tuberculosis by using paired comparative analytic test. All patients expelled sputum spontaneously or with sputum induction on the first day. On the next day, bronchoalveolar lavage (BAL) was performed. The two samples obtained from two methods were examined by AFB examination with staining Ziehl Neelsen (ZN) and cultured of M. tuberculosis on solid media Ogawa on all patients. Positivity, sensitivity and increased sensitivity of AFB and culture of M. tuberculosis in the non bronchoscopic and bronchoscopic groups were compared.Results: there were differences in the positivity level of AFB with ZN staining between non-bronchoscopic and bronchoscopic groups which were 7/40 (17.5%) vs 20/40 (50.0%) (p<0.001). The differences between the cultures of non-bronchoscopic and bronchoscopic groups were 16/40 (40.0%) vs 23/40 (57.5%) (p=0.039). Bronchoscopic sputum increased the positivity level of the ZN AFB examination by 32.5% (from 17.5% to 50.0%) as well as on culture examination by 17.5% (from 40.0% to 57.5%).Conclusion: Bronchoalveolar lavage can improve the positivity level of smears and cultures in patients suspected of pulmonary TB in HIV patients with CD4<200 cells/μL

Mangrove blue carbon stocks and dynamics are controlled by hydrogeomorphic settings and land-use change.

Globally, carbon-rich mangrove forests are deforested and degraded due to land-use and land-cover change (LULCC). The impact of mangrove deforestation on carbon emissions has been reported on a global scale; however, uncertainty remains at subnational scales due to geographical variability and field data limitations. We present an assessment of blue carbon storage at five mangrove sites across West Papua Province, Indonesia, a region that supports 10% of the world's mangrove area. The sites are representative of contrasting hydrogeomorphic settings and also capture change over a 25-years LULCC chronosequence. Field-based assessments were conducted across 255 plots covering undisturbed and LULCC-affected mangroves (0-, 5-, 10-, 15- and 25-year-old post-harvest or regenerating forests as well as 15-year-old aquaculture ponds). Undisturbed mangroves stored total ecosystem carbon stocks of 182-2,730 (mean ± SD: 1,087 ± 584) Mg C/ha, with the large variation driven by hydrogeomorphic settings. The highest carbon stocks were found in estuarine interior (EI) mangroves, followed by open coast interior, open coast fringe and EI forests. Forest harvesting did not significantly affect soil carbon stocks, despite an elevated dead wood density relative to undisturbed forests, but it did remove nearly all live biomass. Aquaculture conversion removed 60% of soil carbon stock and 85% of live biomass carbon stock, relative to reference sites. By contrast, mangroves left to regenerate for more than 25 years reached the same level of biomass carbon compared to undisturbed forests, with annual biomass accumulation rates of 3.6 ± 1.1 Mg C ha-1  year-1 . This study shows that hydrogeomorphic setting controls natural dynamics of mangrove blue carbon stocks, while long-term land-use changes affect carbon loss and gain to a substantial degree. Therefore, current land-based climate policies must incorporate landscape and land-use characteristics, and their related carbon management consequences, for more effective emissions reduction targets and restoration outcomes

Risk Factors Associated with Unsuppressed Viral Load in People Living with HIV Receiving Antiretroviral Treatment in Jawa Barat, Indonesia

Rudi Wisaksana, Yovita Hartantri, Elisabeth Hutajulu Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Elisabeth Hutajulu, Tel +62 81220648061, Fax +62 22 2032216, Email [email protected]: The success rate of antiretroviral therapy (ART) was sufficiently high globally that by 2030, Human Immunodeficiency Virus (HIV) infection would no longer become a significant health issue. The evaluation of the success rate of ART in Indonesia is still fairly low, with estimates that 6.1% of the total population living with HIV. This is affected by treatment failure and limitations of viral load (VL) testing. We investigated the risk factors for failure of VL suppression in HIV patients on ART.Methods: An institution-based cross-sectional study was conducted among 1203 subjects, medical records of adult HIV patients in Jawa Barat, who followed the Viral Load Months Program from the government in 2020. Data were taken using total sampling technique and analyzed with multivariate logistic regression model using SPSS version 21 software.Results: Of the 1203 subjects, 5.2% had unsuppressed VL and 94.8% had suppressed VL. The results showed that a nevirapine-based regimen was the main factor increasing unsuppressed risk (Prevalence Odds Ratio (POR) 3.75 (95% CI: 1.41– 9.99, p-value 0.008)). The other factors are ART duration < 5 years (POR 2.46; 95% CI: 1.22– 4.97, p-value 0.012), WHO clinical stage III–IV (POR 2.30; 95% CI: 1.30– 4.08, p-value 0.004), and loss to follow-up history (POR 2.28, 95% CI: 1.03– 5.07). Meanwhile, the zidovudine-based regimen reduced the risk of failure (POR 0.34 (95% CI: 0.12– 0.96)).Conclusion: Several factors could contribute to unsuppressed VL in HIV patients receiving ART, which warrants further investigations.Keywords: viral load, HIV, risk factors, unsuppressed, antiretroviral therapy, failur

Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study

BACKGROUND: Little is known about HIV treatment outcomes in Indonesia, which has one of the most rapidly growing HIV epidemics worldwide. METHODS: We examined possible differences in loss to follow-up (LTFU) and survival between HIV-infected females and males over a 7-year period in an HIV clinic in Bandung, West Java. Data imputation was performed on missing covariates and a multi-state Cox regression was used to investigate the effects of sex and other covariates on patient transitions among four states: (1) clinic enrollment with HIV, (2) initiation/continuation/re-initiation of antiretroviral therapy (ART), (3) LTFU, and (4) death. RESULTS: We followed 3215 patients (33% females), for a total of 8430 person-years. ART was used by 59% of patients at some point. One-year retention was 73% for females and 77% for males (p = 0.06). One-year survival was 98% for both females and males (p = 0.15). Females experienced a higher relative hazard to transition from HIV to LTFU (adjusted hazard ratio 1.21; 95% confidence interval 1.00-1.45), but this decreased after adjustments for clinical variables (aHR 0.94; 95% CI 0.79-1.11). Similarly, a lower relative hazard in females to transition from ART to death (aHR 0.59; 95% CI 0.35-0.99) decreased after adjustments for demographic variables. CONCLUSION: This Indonesian cohort has low ART uptake and poor overall pre- and post-ART retention. Female-male differences in survival and retention were gone after adjusting for clinical and sociodemographic factors such as CD4 count and education level. Efforts should be made to improve retention among patients with lower education

Virological failure and drug resistance during first line anti-retroviral treatment in Indonesia

The virological response and development of drug resistance during first-line anti-retroviral treatment (ART) were studied in Indonesia where the majority of patients infected with HIV have a history of injecting drug use, which is often linked with lower treatment adherence and development of drug-resistance. As many as 575 patients starting ART between September 2007 and March 2010 in Hasan Sadikin Hospital Bandung were followed prospectively. Clinical and laboratory monitoring was performed every 6 months. Plasma samples with HIV-RNA 400copies/ml were examined for drug resistance mutations. Most patients were male (72.3%), 59.7% had a history of injecting drug use, and the median CD4+ cells count before start of ART was 35cells/mm3 (IQR 10-104). From 438 HIV patients with HIV-RNA measurements, 40 (9.1%) subjects had HIV-RNA 400copies/ml after 24 weeks (median follow-up 16 (IQR 8-25) months). Of these failing patients 16 (47%) subjects had drug resistance mutations, predominantly M184V (35.3%), Y181C (23.5%), K103N (11.7%), and TAMs (11.7%). A history of treatment discontinuation 1 month, reported by 5.3% (23) of patients, was strongly associated with virological failure (adjusted OR 12.64, 95% CI 4.51-35.41); and a history of injecting drug use was not (OR 0.75, 95% CI 0.38-1.46). This is the largest and most systematic evaluation of virological response to first line ART in Indonesia. Patients in this cohort responded well to first line ART, with low rates of virological failure and drug resistance. A history of injecting drug use should not be a reason to withhold ART in this setting. (c) 2013 Wiley Periodicals, Inc

Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: Double blind randomised controlled trial

10.1136/bmj.f3039BMJ (Online)3467911-BMJO