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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