HUBUNGAN GEJALA KLINIS, LUAS LESI RADIOLOGI DAN PEMERIKSAAN SPUTUM BTA DENGAN HASIL CD4+ PADA PASIEN KOINFEKSI TB-HIV DI RS PERSAHABATAN JAKARTA

Novita Andayani

Abstract


Abstrak

Pendahuluan : Jumlah kasus TB paru dengan koinfeksi HIV/AIDS meningkat dengan cepat pada negara-negara berkembang. Agar dapat mendiagnosis dan memulai terapi profilaksis, perlu dilakukan penilaian gejala klinis, luas lesi radiologi dan pemeriksaan sputum BTA dengan perhitungan jumlah CD4+ agar dapat menjadi standar baku. Jumlah dari CD4+ dibutuhkan untuk menentukan tingkat infeksi HIV/AIDS.

Metode : Bentuk penelitian ini berupa cross sectional dengan analisa  deskriptif  dengan penyajian bentuk tabel. Untuk analisis hubungan akan dilakukan uji Kai Kuadrat dan uji Fisher yang akan melihat hubungan antara gejala klinis, foto thoraks dan hasil sputum BTA dengan nilai CD4+ terhadap 74 sampel penderita TB paru dengan koinfeksi HIV.

Hasil : Dari jumlah 74 pasien TB-HIV, 85,1% (n = 63) adalah laki-laki dan 14,9% (n = 11) adalah wanita. Hanya gejala klinis batuk yang terdapat hubungan dengan nilai CD4+ yaitu  pada kelompok pasien dengan nilai CD4+ ≥ 200 sel/µl  persentase lebih tinggi dibandingkan dengan dengan nilai CD4+<200 sel/µl (100% vs 63,1%;P =0,027). Luas lesi foto thoraks dan hasil sputum BTA tidak terdapat hubungan dengan nilai CD4+.

Kesimpulan : Nilai CD4+ tidak dapat memprediksi terjadinya gejala TB-HIV, hampir semuanya mempunyai gejala tidak spesifik. Nilai CD4+ juga tidak dapat memprediksi terdapatnya sputum BTA positif maupun negatif dan hasil foto thoraks dengan lesi luas maupun minimal. (JKS 2012; 2: 81-89)

Abstract

Introduction : The number of cases of pulmonary tuberculosis with HIV/AIDS is increasing rapidly in developing countries. In order to diagnose and initiate prophylactic therapy, it is important to conduct clinical assessments, extensive radiological lesions and sputum smear examination by assessing the number of CD4 + as a gold standards for TB HIV diagnosis. The number of CD4 + is an important data to determine the infection rate of HIV/AIDS.

Methods : This is a cross sectional study with a descriptive analysis presented in tables. The analysis of the relationship conducted by using Kai Square method and Fisher tests, which determine the relationship between clinical symptoms, thoracic photos and sputum smear results with CD4 + values on 74 samples of pulmonary TB patients co-infected with HIV.

Results : Out of 74 patients with TB-HIV infection, 85.1% (n = 63) were male and 14.9% (n = 11) were female. Coughing is the only clinical symtomps that related with CD4 + values, which the percentage of coughing group of patients with a value ≥ 200 CD4 + cells / mL is higher than the percentage of the group with CD4 + <200 cells / mL (100% vs 63.1%, P = 0.027). The width of Thoracic lesions and the results of sputum smear have no correlation with CD4 + values.

Conclusions : CD4 + value cannot predict the occurrence of symptoms of TB-HIV, almost all of them have no-specific symptoms. CD4 + value can not predict neither the presence of bacteria on sputum smear (positive or negative) or the images of thoracic lesions (extensive or minimal). (JKS 2012; 2: 81-89)


Keywords


Koinfeksi TB-HIV; jumlah CD4+; gejala klinis; luas lesi foto thoraks; sputum BTA TB-HIV co-infection; CD4 +; clinical symptoms; broad picture of thoracic lesions; sputum smear

Full Text:

PDF

References


Infectious disease Society of America, The forum for collaborative HIV research HIV/TB coinfection: basic facts. 2007. Georgia, Atlanta 2007. p.1-2

Departemen Kesehatan Republik Indonesia. Kebijakan nasional kolaborasi TB/HIV. Edisi I. Jakarta: Depkes RI; 2007. h.1-5

Aditama TY, Soepandi PZ, Bernida I, Subroto H, Tabrani Z, Sembiring S, et al. Tuberkulosis. Perhimpunan dokter paru Indonesia. Jakarta. 2006. p.5-10

Zar Hj.Chronic lung disease in human immunodefisiency virus (HIV) infected children.Pediatr Pulmonol. 2008 Jan; 43 (1) : 1-10

Centres for Disease Control and Prevention. HIV/AIDS surveillance Report, 2007. Available from : URL. http://www.cdc.gov/hiv/topics/surveillance/resource/reports.

Jones BE, Young SMM, Antoniskis D et al. Relationship of the manifestation of tuberculosis to CD4+ counts in patients with human immunodeficiency virus infection. Am Rev. Respir Dis. 1993 : 148 : 1292-7

Ong CK, Tan WC, Leong KN, Muttalif AR. Tuberculosis-HIV Coinfection: The relationship between manifestation of tuberculosis and the degree of immunosupression (CD4+counts). IeJSME 2008 : 2 : 17-22

Barnes PF, Bloch AB, Davidson PT, Snider DE. Tuberculosis in patients with human immunodeficiency virus infection. NEJM.1991. 324 : 1644-50

L. Aaron, D. shaadoun, I. Calatroni, O. launay et al. TB in HIV infected patients: A comprehensive review. Clin Microbiol Infect. 2004 : 10 : 388-98

Roenn JHV. Management of HIV-related body weight loss. Med. Prog 1995. 22 : 32-8

Maniar JK, Saple DG. Presenting clinical features of HIV disease-Bombay. 3rd International conference on AIDS in Asia and Pasific. 1995 : 20

Jones BE, Ryu R, Yang Z, Cave MD, Pogoda JM, Otaya M, et al. Chest radiographic findings in patients with tuberculosis with recent or remote infection. Am J Respir Crit Care Med. 1997. Oct; 156 (4 Pt 1) : 1270-3

Antoniskis D, Larsen RA, Sattler FR. Current approach to management of oportunistic infection. Curr Science. 1990. 3 : 100-107

Wallis RS, Helfand MS, Whalen CC, Johnsons JL, Mugerwa RD, Vjecha M, et al. Immune activation, allergic drug toxicity and mortality in HIV positive-tuberculosis. Tuber Lung Dis.1996. 77 : 516-23

Chaisson RE, Slutkin G. Tuberculosis and human immunodeficiency virus infection. J Infect Dis 1989. 159 : 96-100

Martin DJ, Sim JG, Total Lymphocyte Count as a Surrogate for CD4+ Lymphocyte Count in African Patients Coinfected With HIV and Tuberculosis. JAIDS. 1996. 11 : 412-3

Perlman DC, El-sadr WM, Nelson ET, Mattis JP, Telzal EE, Salomon N, et al. Variation of Chest radiographic patterns and pulmonary tuberculosis by degree of human immunodeficiency virus related immunosupression. Clim Infect Dis. 1997. 25 : 242-6

Dikromo NP. Faktor-faktor yang mempengaruhi pengobatan pasien koinfeksi TB-HIV di RS persahabatan [Tesis]. Jakarta : Program Pendidikan Dokter Spesialis-I Departemen Pulmonologi dan Ilmu Kedokteran Respirasi FKUI. 2010


Refbacks




Creative Commons LicenseISSN: 1411-3848E-ISSN: 2579-6372
Copyright© 1987-2017 | ISSN: 1412-1026 | EISSN: 2550-0112 
Jurnal Kedokteran Syiah Kuala is licensed under a Creative Commons Attribution 4.0 International License.

 

Published by:
Fakultas Kedokteran, Universitas Syiah Kuala
 
Jl. Tgk. Tanoh Abee, Kopelma Darussalam,
Banda Aceh, 23111, Indonesia.
Phone: +626517551843 
Email: jks@unsyiah.ac.id


Online Submissions & Guidelines | Editorial Policies | Contact | Statistics | Indexing | Citations