Tesis

Perbedaan karakteristik klinis antara pasien HIV dalam terapi antiretroviral dengan risiko kardiovaskular tinggi dan rendah = Clinical Characteristics of HIV Infected Individu on Antiretroviral Therapy with High and Low Cardiovascular Risk.

Latar Belakang. Infeksi HIV masih merupakan masalah kesehatan mayor baik di dunia maupun Indonesia. Sejak dimulainya terapi antiretroviral (ARV), terdapat pergeseran penyebab morbiditas dan mortalitas pasien HIV. Pasien HIV berisiko lebih tinggi mengalami cardiac event melalui berbagai mekanisme. Penilaian risiko kardiovaskular dan faktor-faktor yang memengaruhinya penting untuk dilakukan terhadap semua pasien HIV. Tujuan. Penelitian ini bertujuan untuk mengetahui prediksi risiko kardiovaskular pasien HIV dalam terapi ARV, perbedaan karakteristik klinis antara pasien risiko kardiovaskular tinggi dan rendah, serta hubungan lama penggunaan ARV, kepatuhan minum obat, hitung limfosit T CD4 nadir, serta perubahan indeks massa tubuh (IMT) terhadap risiko kardiovaskular. Metode. Penelitian ini merupakan studi potong lintang yang melibatkan pasien HIV dalam terapi ARV minimal 6 bulan. Setiap pasien yang masuk penelitian dicatat data demografis, riwayat penyakit, pengobatan, dan kebiasaan serta dilakukan pengukuran antropometri. Pasien kemudian diminta datang kembali untuk pemeriksaan profil lipid. Risiko kardiovaskular dihitung dengan D:A:D risk scores dan dituangkan dalam bentuk persentase. Uji hipotesis yang dilakukan adalah uji T atau Mann-Whitney untuk data numerik, dan Chi-square untuk data kategorik. Hasil. Terdapat 186 subjek penelitian yang dimasukkan ke dalam analisis. Proporsi subjek penelitian dengan risiko kadiovaskular tinggi adalah 14,52%. Seluruh subjek yang termasuk ke dalam kelompok risiko tinggi adalah laki-laki dengan usia yang relatif muda. Dislipidemia dan obesitas sentral lazim terjadi pada kelompok risiko tinggi. Terdapat perbedaan bermakna antara hitung limfosit T CD4 nadir dan riwayat putus obat antara subjek risiko tinggi dan rendah (OR:7,072,IK 95%: 0,92 – 54,006, p:0,032 dan OR: 3,364, IK 95%: 1,458 – 7,784, p: 0,003. Selain itu, terdapat perbedaan bermakna median lama penggunaan ARV dan rerata delta IMT antara kelompok risiko tinggi dan rendah (p:0,002 dan p: 0,018). Kesimpulan. Proporsi pasien HIV dengan risiko kardiovaskular tinggi pada penelitian ini sebesar 14,5%. Terdapat beberapa perbedaan bermakna dalam hal hitung limfosit T CD4 nadir, riwayat putus ARV, lama penggunaan ARV dan delta IMT antara subjek dengan risiko kardiovaskular tinggi dan rendah
Kata kunci: HIV, ARV, risiko kardiovaskular, D:A:D.


Background. Human immunodeficienncy virus (HIV) infection remains a major health problem worldwide. Ever since the discovery ov antiretroviral (ARV), there are shift in causes of morbidity and mortality among HIV patients. Patients with HIV are at greater risk to cardiac event due to different mechanisms. Cardiovascular risk assessment and the associated factors are indispensible to do for all HIV patients. Objective. This study aims to predict cardiovascular risk among HIV patients on ARV therapy, to investigate clinical characteristic differences between high risk and low risk group, and to examine the relationship of , nadir limfosit T CD4count, compliance, duration of ARV, and body mass index (BMI) changes toward cardiovascular risk. Method. This study was a cross sectional study involving HIV patient on ARV therapy for at least 6 months. Demographic data, history of illness, therapy, and habit were taken from each patients. Antropometry measurement was also conducted and blood drawing for lipid profile test was performed in the next appointment. Cardiovascular risk was assessed using D:A:D risk score and the proportion was presented in percentage. Hipothesis tests were performed using T test or Mann-Whitney test for numerical data and x 2 test for categorical data. Results. There were 186 subjects included in the analysis. Proportion of subjects with high cardiovascular risk was 14.52%. All subjects with high cardiovascular risk was male with relatively young age. Dyslipidemia and central obesity were very common among patints in high risk group. There were significant difference in proportion of patients with nadir limfosit T CD4 count < 200 cell/mm3 and history of bad compliance between high and low risk group (OR:7,072, 95% CI: 0,92 – 54,006, p:0,032; OR: 3,364,95% CI: 1,458 – 7,784, p: 0,003, respectively). Furthermore, there was also significant differences between median duration of ARV use and mean of IMT changes between two groups (p:0,002 dan p: 0,018). Conclusion. Proportion of HIV patients with high cardiovascular risk in this study was 14.5%. There were significant differences regarding nadir limfosit T CD4 count, history of compliance, duration of ARV use, and IMT changes between subjects with high and low cardiovascular risk.
Keyword: HIV, ARV, cardiovascular risk, D:A:D.