Are We Giving Optimal Dose of Efavirenz?

Antiretroviral is one of the drugs that extensively been studied for its drug-to- drug interaction. Its long term used and the fact that many HIV-infected patients came in the late stage of disease make polypharmacy is unavoidable.Efavirenz is one of antiretroviral drugs that widely used in HIV-infected patients age more than 3 years old in many countries. Latest Indonesian antiretroviral guidelines recommend a combination of tenofovir, lamivudine and efavirenz given orally in one daily dose as the  preferred  primary  fixed-drug  combination treatment. This recommendation is based on many evidence supporting efficacy, tolerability, price, pregnancy safety, simplicity and the availability of the drug that will support the continuing comprehensive care for HIV-infected patients in primary care level

HIV Drug Resistance after Failure of 6 Month First-line Therapy in a Hospital: A Case Series

This is the first report of HIV drug resistance in RSUPN Dr. Cipto Mangunkusumo. We tested We reviewed eleven new cases of HIV patients who had virologic failure after 6 months first-line antiretroviral therapy. With the sequencing method, analysis of gene mutations encoded HIV drug resistance. Genotypic resistance results and HIV-1 subtype were interpreted by Stanford DR database. Of ten plasma samples that were successfully amplified and sequenced, all samples were resistant to at least one antiretroviral drug. Genotypic resistance towards the antiretroviral drugs being used was observed in lamivudine (90%), tenofovir (83%), nevirapine (100%) dan efavirenz (100%). It is interesting that no zidovudine resistance were found, including in four patients receiving zidovudine in their HAART. The common NRTI mutations were M184VI and K65R, while NNRTI mutations were Y181CFGVY, K103N, A98AG, E138GQ and G190AGS. No mayor PI mutations were found. Based on these findings, we supports the need for appropriate virology monitoring and HIV drug resistance survey in clinical practice and access to drug options in case of virology failure

Detection of Cryptosporidium SP Coproantigen in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patient with Chronic Diarrhea

Cryptosporidium sp is one of protozoan that cause diarrhea in immunodeficient patients such as HIV/AIDS. Detection of coproantigen of Cryptosporidium sp is more sensitive than microscopic detection. The objective of this study is to detect cryptosporidiosis using coproantigen detection compare to microscopic detection from stool of HIV/AIDS patients with crhonic diarrhea. A Total of 95 stool specimens from HIV/AIDS patients with chronic diarrhea were received by Laboratorium klinik Parasitologi Faculty of Medicine UI. The stool was tested using coproantigen and microscopy detection for cryptosporidiosis. The frequency of cryptosporidiosis using koproantigen detection was 36.8% while the MTA method was only 11.6%. Sensitivity and specificity of coproantigen detection compared with the microscopic was 100% and 71.4%. Detection coproantigen necessary in patients with high suspicion of cryptosporidiosis but oocysts detection was negative. &nbsp

Profil Pasien Tb-hiv dan Non Tb-hiv di Rscm

Tuberculosis (TB) is the most common opportunistic infection and cause of death in patients with Human Immunodeficiency Virus (HIV) in developing countries. TB-HIV cases showed an increase in recent years. There has been no report on TB-HIV patient profiles in RSCM. The purpose of this study was to obtain data an demographic, clinical, laboratory, and radiological TB-HIV patients. This study was a descriptive cross-sectional study design to document medical records of HIV-TB patients who came for treatment to the Pokdisus RSCM between July 2008-December 2010. A number of 522 patients consisted of 424 males (81.2%) and 98 females (18.8%), with a mean age of 31.92 years, the majority in the age group 18-40 years (90.8), 53.1% married, tribal Betawi 28.4%, and 64.2% graduated from high school. The proportion of injecting drug transmission (56.5%). Concomitant infection is hepatitis C infection (42.9%) and oral candidiasis (26.4%). Chronic cough is the most clinical manifestation (67.5%), followed by prolonged fever (57.5%) and weight loss (50.4%). Patients with sputum smear-negative (36.2%), CD4 <200 (78.0%) and chest X-ray finding of TB (32.8%).Keywords : tuberculosis, hiv.AbstrakTuberkulosis (TB) merupakan infeksi oportunistik terbanyak dan penyebab kematian utama pada pasien Human Immunodeficiency Virus (HIV) di negara berkembang. Kasus TB-HIV menunjukkan kenaikan dalam beberapa tahun terakhir. Belum ada laporan mengenai profil pasien TB-HIV di RSCM. Tujuan penelitian ini adalah untuk mendapatkan data demografi, klinis, laboratoris, dan radiologis pasien TB-HIV. Penelitian ini merupakan rancangan studi potong lintang deskriptif dengan menelusuri rekam medik pasien TB-HIV yang datang berobat ke Kelompok Studi Khusus (Pokdisus) RSCM antara bulan Juli 2008-Desember 2010. Sejumlah 522 penderita yang terdiri dari 424 laki-laki (81,2%) dan 98 wanita (18,8%), dengan usia rerata 31,92 tahun, mayoritas pada kelompok usia 18-40 tahun (90.8), sudah kawin 53.1%, suku Betawi 28,4%, dan tamat SMA 64,2%. Proporsi transmisi narkoba suntik (56,5%). Infeksi penyerta adalah infeksi hepatitis C (42,9%) dan kandidiasis oral (26,4%). Batuk kronik merupakan manifestasi klinik terbanyak (67,5%), diikuti dengan demam lama (57,5%) dan berat badan turun (50,4%). Pasien dengan sputum BTA negatif (36,2%), CD4 <200 (78,0%) dan gambaran TB pada foto toraks (32,8%).Kata kunci : tuberculosis, hiv

Non-Surgical Biliary Drainage on Biliary Obstruction Due to Malignancy

Surgery is still the golden standard of curative therapy for Malignant biliary obstruction, but only 10- 20% of cases considered resectable. Therefore, palliative therapy to relieve pain, cholestasis, and biliary obstruction, is the main treatment for most patients. The development of percutaneous transhepatic biliary drainage and endoscopic biliary drainage had brought about minimally invasive treatment for Malignant biliary obstruction, which had lower morbidity and mortality than surgical drainage. The choice of drainage technique depends on type of tumor, site of obstruction, also the available expert and instrumentation

Acalculous Cholecystitis Prevalence on Abdominal Ultrasonography Examination of HIV/HCV Co-infection Patients in Cipto Mangunkusumo Hospital

Background: Acalculous cholecystitis is commonly found in patients with human immunodeficiency virus (HIV) compared to general population. Surprisingly, the signs and symptoms are unremarkable. On the other hand, HIV/hepatitis C virus (HCV) co-infection is a common finding. The aim of this study was to evaluate whether HCV infection has any influence to HIV patients concerning acalculous cholecystitis prevalence. Method: A cross-sectional study was performed in HIV/HCV patients who visited AIDS study group clinic at Cipto Mangunkusumo hospital during September 2008 to February 2009. The patients who met the criteria were examined physically and underwent abdominal ultrasonography. Routine blood count, alanine aminotranferase, aspartate aminotransferase, cluster of differentiation 4 (CD4) and serum albumin were recorded. Results: Of 63 patients underwent ultrasonography examination, we found acalculous cholecystitis in 33 patients (52.3%), cholelithiasis and cholecystitis in 2 patients, and 28 patients were considered normal. Patients with CD4 less than 200 cells, tend to have acalculous cholecystitis more than those who had CD4 more than 200 cells. Conclusion: The prevalence of acalculous cholecystitis among HIV/HCV co-infection is higher compared to those with HIV infection alone

Intractable Diarrhea Due to Secondary Gastrointestinal Amyloidosis in a Patient with History of Leprosy

Amyloidosis is not a single disease but a term for diseases that share a common feature: the extracellular deposition of pathologic insoluble fibrillar proteins in organs and tissues. In both primary and secondary amyloidosis, the most commonly involved organ system is the gastrointestinal system, with the colon being the most frequently involved organ. A 30 years-old male, complained of diarrhea since 4 months prior to admission. The colonoscopy examination revealed pancolitis, ileitis, and the result from histopathological examination showed chronic destructive ileocolitis with 40-70% amyloidosis of mucosa. The abdominal ultrasonography showed chronic cholecystitis, multiple cholelithiasis and minimally ascites. The esophagogastroduodenoscopy revealed candida esophagitis, erosive pangastritis grade V, pyloring gapping, erosive duodenitis, bile reflux gastritis and esophagitis, and the result from histo-pathological examination showed amyloidosis on gastric mucosa.The immunofixation electrophoresis was negative for monoclonal light chains, and the serum protein electrophoresis showed normal pattern. Enteral and parenteral nutritional therapy were given. Secondary infection was treated by antibiotics. Complication and organ failure occured lately. This chalenging case demonstrated complicated management of gastestinal amyloidosis

Predictors of Mortality in Hospitalized HIV/AIDS Patients

Introduction. Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is a big problem that threatening in Indonesia and many countries in the world. The knowledge on the characteristics and prediction of outcome were important for patients management. There are no studies on the predictors of mortality in Indonesia. Methods. We performed a retrospective cohort study among hospitalized patients with HIV/AIDS in Cipto Mangunkusumo Hospital between 2011-2013. Datas on clinical, laboratory measurement, outcome (mortality) and causes of death during hospitalization were gathered from medical records. Bivariate analysis using Chi- Square test were used to evaluate seven prognostic factors (male sex, not came from referral hospital, never received/failed to continue antiretroviral therapy (ART), clinical WHO stage 4, hemoglobin level <10 g/dL, eGFR level <60 mL/min/1.73 m2 and CD4+ count ≤200 cell/μL). Multivariate logistic regression analysis was performed to identify independent predictors of mortality. Results. Among 606 hospitalized HIV/AIDS patients (median age 32 years; 64.2% males), 122 (20.1%) were newly diagnosed with HIV infection during the hospitalization and 251 (41.5%) had previously received ART. Median length of stay was 11 (range 2 to 75) days. There were 425 (70.1%) patients being hospitalized due to opportunistic infection. In-hospital mortality rate was 23.4% with majority (92.3%) due to AIDS related illnesses. The independent predictors of mortality in multivariate analysis were clinical WHO stage 4 (OR=6.440; 95% CI 3.701-11.203), hemoglobin level <10 g/dL (OR=1.542; 95% CI 1.015- 2.343) and eGFR level <60 mL/min/1.73 m2 (OR=3.414; 95% CI 1.821-6.402). Conclusions. In-hospital mortality rate was 23.4%. Clinical WHO stage 4, hemoglobin level <10 g/dL and eGFR level <60 mL/ min/1.73 m2 were the independent predictors of in-hospital mortality among hospitalized patients with HIV/AIDS

HIV in Geriatrics

Through both prolonged survival and late acquisition of the disease, numbers of older adults with HIV are climbing. Along with ageing process is an accumulation of HIV-associated non-AIDS related comorbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and social issues

Performance of Combination of Symptoms, Chest x-rays and MGIT 960 Culture for Diagnosis of Pulmonary Tuberculosis in HIV Patients

Introduction. The diagnosis of pulmonary tuberculosis in HIV patients remains a clinical challenge for various reason. The clinical feature of pulmonary tuberculosis in HIV patients is atypical and incomplete. This may cause under or overdiagnosis, which consequently contribute to the higher observed death rate in HIV population with the pulmonary tuberculosis. This study aims to identify factors related to the diagnosis of pulmonary tuberculosis in the HIV patient and contribution of MGIT 960 culture. Methods. A cross-sectional study was conducted among HIV patients suspected of having pulmonary tuberculosis from Oktober 2011 to April 2012. The association clinical features (cough, weight loss, fever) and radiologic examination with pulmonary tuberculosis (Lowenstein Jensen culture) was analyzed with logistic regression. Each factors contribution to diagnosis of pulmonary tuberculosis was determined. The performance of MGIT 960 culture was assed with ROC and AUC. Statistical analysis was conducted using SPSS version 16.0. Results. Among total of 100 subject, 30 were confirmed of having tuberculosis. Most of patient were male (63%). The final model of multiple logistics regression analysis revealed two factors associated with pulmonary tuberculosis: fever and weight loss. Abnormalities of chest x-rays was proved unrelated with diagnosis of tuberculosis. The AUC for combination of clinical manifestation was 71% with the addition of MGIT 960 culture, the AUC became 95.7%. Conclusions. Factors related with diagnosis of tuberculosis in HIV patients were fever and weight loss. Mycobacteria Growth Indicator Tube (MGIT) 960 culture would increase tuberculosis diagnosing in HIV patients