Clinical Condition of HIV Patients with Opportunistic Infection in

Clinic Voluntary Counseling and Testing

Rahayu Lubis

, Jemadi

and Ria Masniari Lubis

Faculty of Public Health,Universitas Sumatera Utara, Jalan Universitas No. 21, Medan, Indonesia

Keywords: HIV, OI, VCT, AIDS, Clinical Condition.

Abstract: The number of HIV infected patients in Indonesia around 190,000 to 400,00 in 2016. Opportunistic infection

usually attend in late stadium of HIV infected patients and in Indonesia, majority infection with Tuberculosis

and the prevalence about 5%. The aim of study is to describe the clinical condition of HIV infection patient in

clinic voluntary counselling and testing (VCT). This is the retrospective study. The Population is all HIV

infected patients with opportunistic infection in clinic VCT in Medan. The sample is HIV patients with OI in

clinic VCT with the period of 2016-2017. Data collection from medical records at clinic VCT. Analysis

descriptive data was used and showed in table distribution and frequency. Total 59 respondents were studied.

Mean age is 36.3 years (SD 9.7 ), Male (83.1%), Bataknese (62.7%), with more than 9 years attainment of

respondent’s education (79.7%). There are (68.8%) of respondent have employment (78%). They come to

clinic with CD4 less than 350 u/dl (67.8%), body mass index less than 23 (81.4%), Haemoglobin less than 11

(64.4%), in stadium 4 (72.9%) and receiving antiretroviral therapy not routine (52.5%). The respondent who

have opportunistic infection with Tuberculosis (54.2%) and 71.2% of patients still alive.

1 INTRODUCTION

The World Health Organization (WHO) reported that

36.7 million (30.8-42.9 million) people are HIV

infected worldwide and 1.0 million (0,83-1,2 million)

people died of HIV-related illnesses (WHO, 2017).

The World Health Organization estimates that

8.7million new cases of TB were reported in 2011

and13% of these being co-infected with HIV. Human

immunodeficiency virus and tuberculosis co-

infection is a major public health problem in the

world. Tuberculosis is the leading cause of mortality

and morbidity in HIV infected patients. These two

infections interact on each other, worsening the

prognosis and increasing mortality. Indonesia is the

third ranking of HIV prevalence in Asia Pacific

region, covering over 75% of new infections

(UNAIDS, 2017)

Based on Indonesia Ministry of Health reported

that HIV cases continue to increase and have spread

in 386 districts / cities. The cumulative number of

HIV patients from 1987-2016 was 232,323 people

and the total cumulative AIDS sufferers were 86,725

(Kemenkes RI, 2017). HIV infection poses a threat to

the development of human quality and productivity in

Indonesia. This is indicated by the high rate of HIV

transmission that occurs. HIV-infected patients are

generally transmitted from sexual transmission. The

study reported that the highest risk of HIV

transmission with tuberculosis infection is

transmitted from close contact person (KPAN, 2010).

Another study showed that incidence of opportunistic

infection in HIV patients majority in less CD4 level

because have relationship with human immunity

(Lubis, 2013). Therefeore, opportunistic infection in

HIV patients very important to estimated the

prognostic of the disease. The aim of study is to

describe the clinical condition of HIV infection

patient in clinic voluntary counselling and testing

(VCT)

2 METHODS

This is a retrospective study in clinic voluntary

counselling and testing in Medan. The Population is

all HIV infected patients with opportunistic infection

(OI) in clinic VCT in Medan. The sample is HIV

patients with OI in clinic VCT with the period of

2016-2017. Data collection from medical records at

Lubis, R., Jemadi, . and Lubis, R.

Clinical Condition of HIV Patients with Opportunistic Infection in Clinic Voluntary Counseling and Testing.

DOI: 10.5220/0010090407870789

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

787-789

ISBN: 978-989-758-449-7

787

clinic VCT. Analysis descriptive data was used and

showed in table distribution and frequency

3 RESULT AND DISCUSSION

3.1 Sociodemographic Characteristic

Totally 59 HIV infected patients with opportunistic

infection included in this study Mean age about 36

years (SD 9.7), Male (83.1%), Bataknese (62.7%)

with more than 9 years attainment of respondent’s

education (79.7%). There are (78.8%) of respondent

have employment as non manual worker, such as

government employees or private employees, come

from out of Medan city (61%), for more details can

be seen in Table 1. Similarity with this study in Africa

reported that elevated incidence of opportunistic

infection in HIV patients in productive aged

(WHO,2011). Other study in Malaysia showed that

majority of HIV patients were aged between 20 and

39 years (70.4%) and male (78.2%) (Lubis, 2013)

3.2 Clinical Condition

Regarding the clinical condition of respondent,

majority come to clinic with the CD4 less than 350

u/dl (67.8%), Body mass index < 23 (81.4%),

Haemoglobin level < 11 g% (64.4%), in stadium four

(72.9%) and receiving antiretroviral therapy not

routine (52.5%). The respondent who with

Tuberculosis infection (54.2%) and with status still

alive (71.2%). It can seen in Table 2. Similarity with

this study reported that antiretroviral used for

prevention of opportunistic infection and

consumption antiretroviral must routine to decrease

the viral load (Moore, 2015). Non-adherence

consumption antiretroviral drug is associated with a

poor short-term virological response and accelerates

the development of drug-resistant HIV (Safira, 2018).

Majority of patient with opportunistic infection come

to clinic with anemia (Lienhardt, 2015) and in late

stadium (Bonnet, 2016). HIV infected patients with

low CD4 cells are easier to get opportunistic

infections. There are various kinds of opportunistic

infections, including oral candidiasis, PCP,

tuberculosis, toxoplasmosis, cytomegalo virus,

kaposi sarcoma and others. Tuberculosis infection

with HIV patients is common in Indonesia because

TB incidence is 2

ranked in the world

Table 1. Sociodemographic characteristic of sample

Varibles f (%)

Mean age (± SD) 36.3 (± 9.7)

Gender

Male

Female

49 (83.1)

10 (16.9)

Ethnic

Bataknese

Others

37 (62.7%)

22 (37.2%)

Education

≥ 9 years attainment

< 9 years attainmen

47 (79.7%)

12 (20.3%)

Occupotional type

Not Employment

Employmen

13 (22%)

46 (78%)

Address

Medan city

Others

23 (39%)

36 (61%)

Table 2. Clinical condition of sample

Varibles f (%)

CD4 (u/dl)

≥ 350

< 350

19 (32.2%)

40 (67.8%)

BMI (kg/m

)

≥ 23

< 23

11 (18.6%)

48 (81.4%)

Hb (g%)

≥ 11

< 11

21 (35.6%)

38 (64.4%)

Stadium of HIV

Three

Fou

16 (27.1%)

43 (72.9%)

Antiretroviral therapy

routine

not routine

28 (47.5%)

31 (52.5%)

Opportunistic infection

Others

32 (54.2%)

27 (45.8%)

Status

Died

Alive

17 (28.8%)

42 (71.2%)

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

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4 CONCLUSION

The Majority of HIV patients with opportunistic

infection in mean age 36 years, male, Bataknese, have

more than 9 years attainment of education, have

employment. They come to clinic in less CD4,

anemia, less BMI, in stadium four, receiving

antiretroviral therapy not routine. More than half with

Tuberculosis infection and still alive

ACKNOWLEDGEMENTS

This study supported by DRPM Kemenristek Dikti

fund (Basic Research Scheme) in 2018 based on

contract number 124/UN5.2.3.1/PPM/ KP-

DRPM/2018

REFERENCES

WHO, 2017. Treat all: Policy adoption and implementation

status in countries. Fact sheet. Link:

http://www.who.int/hiv/pub/progressreports/en/

UNAIDS, 2017. UNAIDS DATA 2017. Available in link:

http://www.unaids.org/en/resources/documents/2017/2

017_data_book

Kemenkes RI, 2017. Statistik kasus HIV/AIDS di Indonesia

dilapor s/d Desember 2016, Jakarta

KPAN, 2010. Laporan Komisi Penanggulangan AIDS

Nasional tahun 2010. Kementrian Koordinator Bidang

Kesejahteraan Rakyat Republik Indonesia

Lubis, R., Bulgiba, A., Kamarulzaman, A., Hairi, N. N.,

Dahlui, M., & Peramalah, D. (2013). Predictors of

death in Malaysian HIV-infected patients on anti-

retroviral therapy. Preventive medicine, 57, S54-S56.

Rodwell L, Richard FWB, Moore M, Strathdee SA, Raich

A, et al, 2010. HIV Tuberculosis Coinfection in

Southern California: Evaluating Disparities in Disease

Burden. Am J Public Health (Suppl 1): S178–S185

Hermans SM, Kiragga A, Schaefer P, Kambugu A,

Hoepelman AIM, et al, 2010. Incident Tuberculosis

during Antiretroviral Therapy Contributes to

Suboptimal Immune reconstitution in a Large Urban

HIV Clinic in Sub-Saharan Africa. PLoS ONE 5(5)

WHO, 2011. World Health Organization Guidelines for

intensified tuberculosis casefinding and isoniazid

preventive therapy for people living with HIV in

resourceconstrained settings. Geneva.

Moore D, Liechty C, Ekwarua P, Werea W, Mwimaa G, et

al, 2017. Prevalence, incidence and mortality associated

with Tuberculosis in HIVinfected patients initiating

antiretroviral therapy in rural Uganda. AIDS 21 (6)

Lienhardt C, Fielding K, Sillah JS, Bah B, Gustafson P, et

al, 2015. Investigation of the risk factors for

tuberculosis: a case-control study in three countries in

West Africa. Int J of Epidemiol 34: 914–923

Bonnet MMB, Loretexu LPP, Francis FVV, Barbara BOO,

Daniel DOO’B, et al.2016. Tuberculosis after HAART

initiation in HIV-positive patients from five countries

with a high tuberculosis burden. AIDS 20(9):1275–

1279

Safira, N., Lubis, R., & Fahdhy, M. (2018). Factors

Affecting Adherence to Antiretroviral Therapy. KnE

Life Sciences, 4(4), 60–70. doi:

HTTPS://DOI.ORG/10.18502/KLS.V4I4.2264

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