Tesis

Laju Insidens dan Faktor-Faktor Terjadinya Herpes Zoster pada Pasien Imunokompromi di Rumah Sakit Cipto Mangunkusumo = Incidence Rate and Factors of Herpes Zoster in Immunocompromised Patients at Cipto Mangunkusumo Hospital.

Latar belakang: Herpes zoster (HZ) merupakan infeksi virus laten yang berisiko tinggi terjadi pada individu dengan kondisi imunokompromi. Data epidemiologis dan faktor risiko HZ pada pasien lupus eritematosus sistemik (LES), keganasan hematologi, dan resipien transplantasi ginjal di Indonesia masih terbatas. Tujuan: Mengevaluasi insidens kumulatif herpes zoster dan menganalisis faktor risiko spesifik yang berasosiasi dengan kejadian HZ pada tiga kelompok pasien imunokompromi di RS Cipto Mangunkusumo. Metode: Penelitian ini merupakan studi kohort retrospektif dengan desain observasional analitik. Subjek terdiri dari pasien dewasa dengan diagnosis LES, keganasan hematologi, atau transplantasi ginjal yang menjalani rawat jalan di tiga poliklinik spesialis. Data diperoleh melalui wawancara terstruktur terkait riwayat HZ sejak diagnosis penyakit dasar hingga saat pengumpulan data. Konfirmasi melalui rekam medis dilakukan apabila tersedia. Setiap subjek diobservasi secara retrospektif sejak diagnosis hingga kejadian HZ atau akhir periode pengamatan. Analisis bivariat dan multivariat dilakukan menggunakan uji chi-square dan regresi logistik. Rasio prevalensi digunakan untuk mengukur kekuatan asosiasi. Hasil: Sebanyak 401 subjek dianalisis: 130 pasien LES, 144 pasien keganasan hematologi, dan 127 pasien transplantasi ginjal. Insidens kumulatif HZ tertinggi ditemukan pada kelompok LES (16,03%) dengan laju insidens 28,65/1000 person-years, disusul kelompok transplantasi ginjal (15,75%) dengan laju insidens 24,47/1000 person-years), dan keganasan hematologi (9,03%) dengan laju insidens 39,51/1000 person-years). Pada kelompok LES, durasi penyakit ≤1 tahun (RR 5,23; IK95%: 1,83–14,99; p = 0,002) dan penggunaan mikofenolat (RR 3,02; IK95%: 1,11–8,25; p = 0,031) merupakan faktor signifikan. Pada kelompok keganasan hematologi, tidak ditemukan faktor yang signifikan secara statistik. Pada kelompok transplantasi ginjal, hanya pemberian pulse metilprednisolon yang signifikan (RR 3,28; IK95%: 1,39–7,75; p = 0,007). Kesimpulan: Herpes zoster paling cepat terjadi pada pasien dengan keganasan hematologi, diikuti LES dan transplantasi ginjal. Faktor yang signifikan mencakup durasi penyakit pendek dan penggunaan mikofenolat pada pasien LES, serta pulse steroid pada pasien transplantasi ginjal. Temuan ini menegaskan pentingnya skrining risiko dan strategi pencegahan yang lebih terarah, termasuk pertimbangan vaksinasi HZ pada populasi imunokompromi berisiko tinggi.
Kata kunci: herpes zoster, insidens kumulatif, faktor risiko, kohort retrospektif, lupus eritematosus sistemik, keganasan hematologi, transplantasi ginjal


Background: Herpes zoster (HZ) is a latent viral infection that carries a high risk of reactivation in individuals with immunocompromised conditions. Epidemiological data and risk factor profiles of HZ in patients with systemic lupus erythematosus (SLE), hematologic malignancies, and kidney transplant recipients remain limited in Indonesia. Objective: To evaluate the incidence rate of herpes zoster and analyze specific risk factors associated with HZ occurrence among three groups of immunocompromised patients at Dr. Cipto Mangunkusumo National Referral Hospital. Methods: This was a retrospective cohort study with an analytical observational design. Adult patients with a confirmed diagnosis of SLE, hematologic malignancy, or post-kidney transplantation status were recruited from three outpatient specialty clinics. Data were collected via structured interviews regarding HZ history from the time of primary disease diagnosis until the point of data collection, confirmed through medical records when available. Bivariate and multivariate analyses were performed to determine associations between clinical variables and HZ occurrence. Prevalence ratios (PR) were used to quantify associations. Results: A total of 401 subjects were included: 130 with SLE, 144 with hematologic malignancy, and 127 with kidney transplantation. The highest cumulative incidence of HZ was found in the SLE group (16.03%) with an incidence rate of 28.65 per 1000 person-years, followed by the kidney transplant group (15.75%; 24.47 per 1000 person-years), and the hematologic malignancy group (9.03%; 39.51 per 1000 person-years). In the SLE group, disease duration ≤1 year (RR 5.23; 95% CI: 1.83–14.99; p = 0.002) and use of mycophenolate (RR 3.02; 95% CI: 1.11–8.25; p = 0.031) were identified as significant factors. In the hematologic malignancy group, no statistically significant risk factors were identified. In the kidney transplant group, only the use of pulse methylprednisolone was significantly associated with HZ (RR 3.28; 95% CI: 1.39–7.75; p = 0.007). Conclusion: Herpes zoster occurred most rapidly in patients with hematologic malignancies, followed by those with SLE and kidney transplants. Significant factors included short disease duration and mycophenolate use in SLE, and pulse steroid therapy in kidney transplant recipients. These findings underscore the importance of risk screening and targeted preventive strategies, including consideration of HZ vaccination in high-risk immunocompromised populations.
Keywords: herpes zoster, cumulative incidence, risk factors, retrospective cohort, systemic lupus erythematosus, hematologic malignancy, kidney transplantation