Aspek diagnosis dan tatalaksana pasien koinfeksi human immunodeficiency virus (HIV) dengan tuberkulosis (TB): Tantangan bagi klinisi di daerah perifer
DOI:
https://doi.org/10.36216/jpd.v6i2.184Keywords:
HIV, TB, koinfeksi, tatalaksana OAT, ARVAbstract
Koinfeksi pasien human immunodeficiency virus (HIV) dengan tuberkulosis (TB) akan mempercepat perburukan kondisi klinis penderita. Infeksi HIV menurunkan kekebalan tubuh penderita, sehingga mempermudah terjadinya infeksi TB. Pasien HIV dengan TB juga akan lebih mudah jatuh pada kondisi yang berat. Seorang pasien laki-laki usia 45 tahun datang ke Instalasi Gawat Darurat (IGD) dengan keluhan lemas seluruh tubuh, disertai dengan riwayat demam naik turun selama kurang lebih tiga bulan serta batuk. Pasien juga disertai dengan penurunan berat badan drastis dan diare selama dua minggu yang hilang timbul. Konjungtiva tampak anemis, mukosa mata kering dan mata cowong. Pemeriksaan fisik dada didapatkan ronki basah kasar pada kedua lapang paru. Hasil laboratorium didapatkan leukositosis dengan rapid test antibody HIV positif. Pemeriksaan rontgen thoraks didapatkan perselubungan bentuk bulat, batas relative tegas pada parakardial paru kanan. Tes cepat molekular sputum didapatkan MTB positif, Sensitif RIF. Pasien didiagnosis dengan HIV stadium 4, TBC paru aktif, gastroenteritis dengan dehidrasi sedang berat, oroesofageal kandidiasis, dan anemia ringan. Pasien diberikan obat anti TB (OAT) kategori 1 sebanyak 4 tablet tiap 24 jam oral. Pasien juga direncakan mendapat obat antiretroviral (ARV) dua minggu setelah pemberian OAT. Pasien dipulangkan dalam kondisi membaik dan delapan bulan setelah masuk rumah sakit, pasien mengalami perbaikan dengan peningkatan berat badan dan tidak ditemukan infeksi oportunistik. Koinfeksi HIV dengan TB perlu menjadi perhatian dalam penanganan yang menyeluruh sehingga efek merugikan dari pemberian obat dan penyakit dapat ditangani dengan baik.
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References
World Health Organization. Global Tuberculosis Report 2020. Geneva: World Health Organization; 2020.
Kementerian Kesehatan RI. Buku Petunjuk TB-HIV untuk Petugas Kesehatan. Jakarta: Direktorat Pencegahan dan Pengendalian Penyakit; 2018.
Kementerian Kesehatan RI. Panduan Pelaksanaan Program Kolaborasi TB-HIV. Jakarta: Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan; 2015.
de Noronha ALL, Bafica A, Noguera L, dkk. Lung granulomas from Mycobacterium tuberculosis/HIV-1 co-infected patients display decreased in situ TNF production. Pathol Res Pract. 2008;204:155-161.
Bezuidenhout J, Roberts T, Muller L, dkk. Pleural tuberculosis in patients with early HIV infection is associated with increased TNF-α expression and necrosis in granulomas. PLoS One. 2009;4:e4228.
Nakata K, Rom WN, Honda Y, dkk. Mycobacterium tuberculosis enhances human immunodeficiency virus-1 replication in the lung. Am J Respir Crit Care Med. 1997;155: 996-1003.
Hoshino Y, Nakata K, Hoshino S, dkk. Maximal HIV-1 replication in alveolar macrophages during tuberculosisrequires both lymphocyte contact and cytokines. J Exp Med. 2002;195:495-505.
Lawn SD, Butera ST, Shinnick TM. Tuberculosis unleashed: the impact of human immunodeficiency virus infection on the host granulomatous response to Mycobacterium tuberculosis. Microbes Infect. 2002;4:635-646.
Kalsdorf B, Scriba TJ, Wood K, dkk. HIV-infection impairs the bronchoalveolar T-cell response to mycobacteria. Am J Respir Crit Care Med. 2009;180:1262-1270.
Rosas-Taraco AG, Acre-Mendoza AY, Caballero-Olin G, dkk. Mycobacterium tuberculosis upregulates coreceptors CCR5 and CXCR4 while HIV modulates CD14 favoring concurrent infection. AIDS Res Hum Retrovirus. 2006;22:45-51.
Juffermans NP, Speelman P, Verbon A, dkk. Patients with active tuberculosis have increased expression of HIV coreceptors CXCR-4 and CCR5 on CD4+ T cells. Clin Infect Dis. 2001;32:650-652.
Kedzierska K, Crowe SM, Turville S, dkk. The influence of cytokines, chemokines, and their receptors on HIV-1 replication on monocytes and macrophages. Rev Med Virol. 2003;13:39-56.
Briken V, Porcelli SA, Besra GS, dkk. Mycobacterial lipoaraninomannan and related lipoglucans: from biogenesis to modulation of the immune response. Mol Microbiol. 2004;53:391-403.
Amin Z, Bahar A. Tuberculosis Paru. Dalam: Buku Ajar Ilmu Penyakit Dalam-Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia. Jilid 6. Jakarta: ;2014. p. 863-881.
Suchindran S, Brouwer ES, Van Rie A. Is HIV infection a risk factor for multi-drug resistant tuberculosis? A systematic review. PLoS One. 2009;4(5):e5561.
Varghese GM, Janardhanam J, Ralph R, dkk. The twin epidemic of Tuberculosis & HIV. Curr Infect Dis Rep. 2013;15:77-84.
Ribera E, Pou L, Lopez RM, dkk. Pharmacokinetic interaction between Nevirapine and Rifampicin in HIV-infected patients with tuberculosis. J Acquir Immune Defic Syndr. 2001;28:450-453.
Bourgarit A, Carcelain G, Martinez V, dkk. Explosion of Tuberculin-spesific Th1-responses induces immune restoration syndrome in tuberculosis and HIV co-infected patients. AIDS. 2006;20:F1-F7.
Vignesh R, Kumarasamy N, Lim A, dkk. TB-IRIS after initiation of antiretroviral therapy is associated with expansion of free-existent Th1 response against Mycobacterium tuberculosis antigens. J Acquir Immune Defic Syndr. 2013;64:241-248.
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