PENURUNAN CD4 PADA ODHA SETELAH TERAPI ARV LEBIH DARI 39 BULAN
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Abstract
Nilai hitung CD4 telah dijadikan indikator efikasi terapi antiretroviral (ARV). Peningkatan nilai hitung CD4 diharapkan terjadi setelah terapi dilakukan, tetapi penurunan nilai hitung CD4 ditemui pada ODHA yang diterapi dalam jangka waktu lama. Anemia dianggap sebagai salah satu penyebab penurunan nilai hitung CD4. Penelitian ini bertujuan melihat hubungan terapi ARV terhadap perubahan nilai hitung CD4 sebelum dan sesudah terapi, dan hubungan anemia terhadap perubahan nilai hitung CD4. Populasi adalah ODHA yang terdaftar di RS. Mitra Masyarakat, Mimika. Sampel adalah 90 ODHA yang terdaftar di VCT RS. Mitra Masyarakat, Mimika yang sudah menerima terapi ARV lebih dari 6 bulan. Sebanyak 67 dari 90 subyek yang memiliki data CD4 sebelum dan sesudah terapi dianalisis menggunakan uji wilcoxon. Hubungan anemia dengan perubahan nilai hitung CD4 dianalisis menggunakan chi square. Mayoritas subyek penelitian adalah perempuan sebanyak 49 orang (73,1%), dengan kelompok umur 25-35 tahun yaitu 27 orang (40,3%). Sebanyak 38 orang (56,7%) diterapi ARV kurang dari 39 bulan, dan sisanya lebih dari 39 bulan. Uji statistik menunjukkan bahwa terdapat penurunan nilai hitung CD4 meskipun telah diterapi ARV, tetapi anemia bukan faktor risiko penyebab penurunan tersebut. Untuk itu, perlu dilakukan evaluasi berkesinambungan pada ODHA yang diterapi ARV.
References
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14. Kelley CF, Kitchen CMR, Hunt PW, et al. Incomplete Peripheral CD4(+) Cell Count Restoration in HIV-Infected Patients Receiving Long-Term Antiretroviral Treatment. Clin Infect Dis. 2009;48(6):787-794.
15. Julg B, Poole D, Ghebremichael M, et al. Factors Predicting Discordant Virological and Immunological Responses to Antiretroviral Therapy in HIV-1 Clade C Infected Zulu/Xhosa in South Africa. PLoS One. 2012;7(2):7-11.
16. Kaufmann GR, Furrer H, Ledergerber B, et al. Characteristics, Determinants , and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/uL in HIV Type 1 – Infected Individuals Receiving Potent Antiretroviral Therapy. Clin Infect Dis. 2005;41:361-372.
17. Tesfaye Z, Enawgaw B. Prevalence of Anemia Before and After Initiation of Highly Active Antiretroviral Therapy Among HIV Positive Patients in Northwest Ethiopia: A Retrospective Study. BMC Res Notes. 2014;7:1-5.
18. Engsig FN, Zangerle R, Katsarou O, et al. Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years with Incomplete CD4 Recovery. Clin Infect Dis. 2014;58(9):1312-1321.
HIV- Infected Patients in Tigray, Northern Ethiopia: A Retrospective Cross-Sectional Study. PLoS One. 2015;652:1-9.
2. Mlisana K, Werner L, Garrett NJ, et al. Rapid Disease Progression in HIV-1 Subtype c-Infected South African Women. Clin Infect Dis. 2014;59(9):1322-1331. DOI:10.1093/cid/ ciu573.
3. Okoye AA, Picker LJ. CD4+ T Cell Depletion in HIV Infection: Mechanisms of Immunological Failure. Immunol Rev. 2014;254(1):5464.
4. Arts EJ, Hazuda DJ, Bushman EFD, Nabel GJ, Swanstrom R. HIV-1 Antiretroviral Drug Therapy. 2012.
5. Dirjen P2PL KK. Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral Pada Orang Dewasa.; 2011.
6. Arts EJ, Hazuda DJ, Swanstrom R, et al. HIV1 Antiretroviral Drug Therapy. Cold Spring Harb Perspect Med. 2012;2(4):a007161.
7. Muzah BP, Takuva S, Maskew M. Risk Factors for Discordant Immune Response Among HIV-Infected Patients Initiating Antiretroviral Therapy : A Retrospective Cohort Study. SAJHIVMED. 2012;13(4):168-172.
8. Daka D, Lelissa D, Amsalu A. Prevalence of Anaemia Before and After the Initiation of Antiretroviral Therapy at ART centre of Hawassa. 2013;3(1):1-6.
9. Curkendall, S.M., Richardson, J.T., Emons, M.F., Fisher, A.E. & Everhard F. Incidence of Anaemia Among HIV Infected Patients Treated with Highly Active Antiretroviral Therapy. HIV Med. 2007;8:483 – 490.
10. Dash KR, Meher LK, Hui PK, Mohanty SP, Nayak SN. High Incidence of Zidovudine Induced Anaemia in HIV Infected Patients in Southern Odisha. Indian J Hematol Blood Transfus. 2012;28 (4)(October):242.
11. Sullivan BPS, Hanson DL, Chu SY, Jones JL, Ward JW. Epidemiology of Anemia in Human Immunodeficiency Virus (HIV)-Infected Persons: Results From the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project. 2016.
12. Ditjen PP & PL Kemenkes RI. Statistik Kasus HIV/AIDS Di Indonesia Dilapor S/d September 2014.; 2014.
13. Brady RL, Dodson EJ, Dodson GG, et al. Crystal Structure of Domains 3 and 4 of Rat CD4: Relation to the NH2-Terminal Domains. Science. 1993;260(5110):979-983.
14. Kelley CF, Kitchen CMR, Hunt PW, et al. Incomplete Peripheral CD4(+) Cell Count Restoration in HIV-Infected Patients Receiving Long-Term Antiretroviral Treatment. Clin Infect Dis. 2009;48(6):787-794.
15. Julg B, Poole D, Ghebremichael M, et al. Factors Predicting Discordant Virological and Immunological Responses to Antiretroviral Therapy in HIV-1 Clade C Infected Zulu/Xhosa in South Africa. PLoS One. 2012;7(2):7-11.
16. Kaufmann GR, Furrer H, Ledergerber B, et al. Characteristics, Determinants , and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/uL in HIV Type 1 – Infected Individuals Receiving Potent Antiretroviral Therapy. Clin Infect Dis. 2005;41:361-372.
17. Tesfaye Z, Enawgaw B. Prevalence of Anemia Before and After Initiation of Highly Active Antiretroviral Therapy Among HIV Positive Patients in Northwest Ethiopia: A Retrospective Study. BMC Res Notes. 2014;7:1-5.
18. Engsig FN, Zangerle R, Katsarou O, et al. Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years with Incomplete CD4 Recovery. Clin Infect Dis. 2014;58(9):1312-1321.
Authors
Hutapea, H. M. L., Mirino, Y., Widiyanti, M., Fitriana, E., Maladan, Y., & Oktavian, A. (2017). PENURUNAN CD4 PADA ODHA SETELAH TERAPI ARV LEBIH DARI 39 BULAN. Media Kesehatan Masyarakat Indonesia, 13(3), 267-272. https://doi.org/10.30597/mkmi.v13i3.1048
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