Tesis

Imunodiagnosis Tuberkulosis dengan Interferon Gamma Release Assay dan Uji Tuberkulin pada Anak dengan Infeksi HIV = Immunodiagnosis of Tuberculosis with Interferon Gamma Release Assay and Tuberculin Test in HIV Infected Children.

Latar belakang: Tuberkulosis (TB) dan Human Immunodeficiency Virus (HIV) merupakan salah satu penyebab utama kematian pada anak. Diagnosis dini penting untuk mengontrol angka mortalitas TB pada infeksi HIV. Uji tuberkulin dan interferon gamma release assay [IGRA, QuantiFERON®-TB Gold In-Tube (QFT-GIT)] diharapkan dapat mendeteksi lebih dini adanya infeksi TB pada HIV. Tujuan: Mengetahui akurasi diagnostik dari QFT-GIT dan uji tuberkulin dalam mendiagnosis TB pada anak usia 1 bulan-15 tahun dengan infeksi HIV. Metode: Penelitian potong lintang dilakukan pada 48 pasien HIV tersangka TB usia 1 bulan-15 tahun. Pengambilan data dilakukan dengan melakukan anamnesis, pemeriksaan fisis, Rontgen toraks, uji tuberkulin, QFT-GIT, dan pemeriksaan bakteriologis (Xpert MTB/RIF dan biakan MGIT). Hasil: Prevalens TB pada anak HIV adalah 20,9% (confirmed TB 4,2% dan possible TB 18,7%). Gambaran klinis anak dengan infeksi HIV yang terdiagnosis TB adalah: batuk lama (90%), penurunan BB (80%), penurunan aktivitas (80%), pembesaran KGB (60%), dan demam lama (50%). Sensitivitas QFT-GIT terhadap possible TB pada anak dengan infeksi HIV adalah 38% (IK 95%: 12-77%), spesifisitas 100% (IK 95%: 98-100), NDP 100% (IK 95%: 98-100), sedangkan NDN 88% (IK 95%: 76-94). Sensitivitas uji tuberkulin terhadap possible TB adalah 29% (IK 95%: 8-64%), spesifisitas 97% (IK 95%: 87-100), NDP 67% (IK 95%: 21-94), sedangkan NDN 88% (IK 95%: 76-95%). Sensitivitas QFT-GIT terhadap pemeriksaan bakteriologis 50% (IK 95%: 9-91%), spesifisitas 96% (IK 95%: 85-99%), NDP 33% (IK 95%: 6-79%), sedangkan NDN 98% (IK 95%: 88- 100%). Akurasi uji tuberkulin terhadap pemeriksaan bakteriologis tidak dapat dinilai. Simpulan: Pemeriksaan dengan QFT-GIT untuk mendeteksi TB pada anak dengan infeksi HIV lebih unggul dibandingkan uji tuberkulin, sehingga dalam pelayanan kedua pemeriksaan ini dapat menjadi pilihan sesuai ketersediaan dan kenyamanan pasien.
Kata kunci: TB, HIV, uji tuberkulin, QFT-GIT, pemeriksaan bakteriologis


Background: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are the leading causes of child mortality in the world. Early diagnosis is important to manage the mortality rate caused by TB in HIV infected children. Tuberculin test (TST) and interferon gamma release assay [IGRA, QuantiFERON®-TB Gold InTube (QFT-GIT)] are expected to help early diagnosis of TB infection in HIV infected children. Objective: To evaluate the accuracy of QFT-GIT and TST as a method to diagnose TB in HIV infected children aged 1 month to 15 years old. Method: A cross-sectional study was conducted in 48 HIV infected children with suspected TB aged 1 month to 15 years old. Data which included history taking, physical examination, thorax radiology, TST, QFT-GIT and bacteriological examination (Xpert MTB/RIF and MGIT culture) were collected. Result: The prevalence of TB in HIV infected children are 20.9% (confirmed TB 4.2% dan possible TB 18.7%). The clinical symptoms of HIV infected children with TB are: chronic cough (90%), body weight decrement (80%), reduction of activity (80%), lymphnode enlargement (60%), and prolonged fever (50%). The sensitivity of QFT-GIT towards possible TB in HIV infected children is 38% (CI 95%: 12-77%), specificity 100% (CI 95%: 98-100), PPV 100% (CI 95%: 98-100), and NPV 88% (CI 95%: 76-94). The sensitivity of tuberculine test towards possible TB is 29% (CI 95%: 8-64%), specificity 97% (CI 95%: 87-100), PPV 67% (CI 95%: 21-94), and NPV 88% (CI 95%: 76-95%). The sensitivity of QFTGIT towards bacteriological examination is 50% (CI 95%: 9-91%), specificity 96% (CI 95%: 85-99%), PPV 33% (CI 95%: 6-79%), and NPV 98% (CI 95%: 88- 100%). Accuracy towards bacteriological examination and tuberculine test could not be evaluated. Conclusion: TB diagnosis with QFT-GIT to detect TB in HIV infected children is slightly superior than TST. Therefore, these two methods could be a choice depending on its availability and patient’s comfort.

Key words: TB, HIV, TST, QFT-GIT, bacteriological examination