4
Data collection is done retrospective one by collecting medical record data in term
of cohort patient at VCT Voluntary Counselling and Testing clinic in Sanglah
Hospital from January 2009 to December 2009.
B. RESEARCH FIELD
This research is conducted at VCT Sanglah Hospital Denpasar from May to
August 2011. C. Research Tools and Materials
1. Research Tools
The tools used is a computer as data processing to make easy in research
implementation, work sheet in term of table for data collection so it will be obtained
information of ARV usage pattern for new patients of adult HIVAIDS-TB and the
increase of CD4
+
patient for the period of January-December 2009.
2. RESEARCH MATERIALS
The materials used in this research is medical record data for adult HIVAIDS-TB
cohort patients in clinic VCT RSUP Sanglah Denpasar who were entering since January
2009-December 2009. In the meanwhile, the increase of CD4
+
data is examined every 6 months, and observed for twice examinations,
so period of result data collection of CD4
+
improvement is from June 2009 – December 2010.
D. Inclusion Criteria
Inclusion criteria
is a
general characteristic of research subject toward
targeted and reachable populations. Inclusion criteria in this research is all adult HIVAIDS-
TB patients for the first time using ARV. E. Samples
Samples in this research are taken by applying consecutive sampling method for
verifying the increase percentage of CD4
+
from ARV combination of new adult HIVAIDS-TB patients.
F. Permission
In sample collection, the first thing to do is to have prior permission to Director
Sanglah Hospital, and staff at Clinic VCT Sanglah Hospital Denpasar.
RESULTS AND DISCUSSION Data collected retrospective and samples
obtained by applying consecutive sampling method. Total initial data obtained by the
researcher is at 62 HIVAIDS-TB patients who were the first time to use ARV at Clinic VCT
Sanglah Hospital since January to December 2009. From this total initial data is then
conducted inclusion so it is obtained 22 patients.
1. Patient Demography HIVAIDS-TB a. Sex
From 22 patients as samples, there are 16 male patients and 6 female ones.
b. Patient Age
From 22 patients, 4 patients are among 21-29 years old, 12 patients are among 30-39
years old and 6 patients are among 40-59 years old. The youngest patients as samples are 21
years old for total 1 patient only, while the oldest one is 49 years old for total 1 patient
only. c. Patient of origin
As referred hospital, so patients at Clinic VCT Sanglah Hospital are from some
areas in Bali, such as from Denpasar at 10 patients, Sanur 1 patient, Gianyar 3 patients,
Karangasem 2 patients, Mengwi 1 patient, Jembrana 1 patient, Tabanan 2 patients,
Abiansemal 1 patient, and Batubulan 1 patient. 2. Type of TB Opportunistic Infection
toward HIVAIDS patients
From 22 samples of HIVAIDS patients with TB opportunistic infection
diagnose, it was found 2 types of TB, namely TB Pulmonary and Duplex KP. At 20 patients
suffered from TB pulmonary, while 2 patients suffered from Duplex TB.
3. Applied ARV Combination
From patients data obtained, there are 3 combination
of ARV
applied, namely
AZT+3TC+EFV, AZT+3TC+NVP,
and d4T+3TC+EFV, where the three are first line
combination for
HIVAIDS-TB patients
Dekpes RI, 2007.
5
Figure 1. The pattern of the First Line ARV Therapy for HIVAIDS-TB Patients in VCT
Clinic Sanglah Hospital during January- December 2009
From 22 patients as samples, there are 14 patients or 64 applying AZT+3TC-EFV
combination. Further, there are 7 patients or 32 applying AZT+3TC+NVP combination.
Only 1 patient or 4 applying d4T+3TC+EV combination where it is the first line
combination for HIVAIDS-TB patients that has low Hb level Depkes RI, 2007a.
4. ARV combination used for patients
with opportunistic
pulmonary infections tuberculosis and KP duplex
First-line combination for pulmonary TB patients and KP Duplex is similar, namely
AZT +3TC + NVP, but the use of Anti Tuberculosis Drugs and ARV combination can
simultaneously cause drug interactions. One of ARV given namely nevirapine when it is used
in conjunction with anti tuberculosis drug, that may result in interactions, namely Rifampicin
reduces blood levels of nevirapine at 30- 555micro liter and also lowers the blood
levels of most protease inhibitors Alcorn, 2010. Thus, if patients with HIVAIDS with
TB opportunistic infection taking Rifampicin and ARV simultaneously, the combination of
first-line antiretroviral Efavirenz is used AZT +3 TC + EFV. Whereas if the HIVAIDS
patients with TB opportunistic infections does not use Rifampicin, it can still be given a
combination of AZT +3 TC + NVP Depkes RI, 2007a.
Selection of antiretroviral combination for patients with TB opportunistic infections
are also based on the specific circumstances of each patient such as anemia and allergic
reactions. A total of 7 patients who are allergic to rifampin, they can be replaced with other
OAT namely streptomycin, so that nevirapine can be administered to the patient without
interaction. And if the patients hemoglobin level examination is known to have anemia
N.K.N.S, then the provision of Zidovudine AZT is replaced with Stavudine d4T,
because AZT has side effects such as anemia. So the appropriate combination given to the
patient is d4T +3TC + EFV. Overview types of TB and ARV combinations used can be
seen in the figure below.
Figure 2. ARV Combination used for patients with opportunistic pulmonary
infections tuberculosis and KP duplex
In this study, as shown in Figure 2, there are 2 patients who suffer from KP Duplex
given the combination of AZT +3TC + EFV. For total of 12 patients with pulmonary
tuberculosis use combination of AZT +3TC + EFV, 7 patients with pulmonary tuberculosis
using a combination AZT +3TC + NVP, and 1 pulmonary TB patient using the combination
of d4T +3 TC + EFV. Patient N.K.N.S get therapy combination d4T +3 TC + EFV as
having a low hemoglobin level, namely 10 g dl, whereas normal Hb levels in adult women
is 12-16 g dl Depkes, 2007a. 5. The increase of CD4
+
toward ARV Combination of HIVAIDS-TB Patient
14 7
1
Applied ARV Combina0on
AZT+3TC+EFV AZT+3TC+NVP
d4T+3TC+EFV
2 4
6 8
10 12
12 7
1 2
A mou
n t of P
ati en
t
ARV Combination
TB Pulmonary KP Duplex
6
From changing of total CD4
+
for 1 year of using ARV, it can be monitored an increase
or decrease in CD4
+
patients. The increase and decrease of CD4
+
according to ΔCD4
+
can be seen in the table below.
Figure 3. Increase and decrease of CD4 + HIVAIDS-TB in VCT clinic Sanglah
Hospital during January-December 2009 based on ΔCD4
+
From the results obtained, the combination of AZT +3 TC + EFV was given to 14 patients
whom 12 patients having increased value CD4
+
and 2 patients with a decline value of CD4
+
after the usage of 12 months, whilst the combination of d4T +3TC + NVP given to 7
patients with 6 patients had a increased value of CD4
+
and 1 patient with CD4
+
values decreased after 12 months of use, while d4T
+3 TC + EFV combination given to 1 new patient showed improvement.
6. The increased of CD4
