Tesis

Dampak Anti Retroviral (ARV) pada HIV Anak: Kajian pada Perubahan Nilai Intelligence Quotient (IQ) dan Elektroensefalografi (EEG) = The Impact of Antiretroviral (ARV) Treatment on HIV-infected Children: an Evaluation on Altered Intelligence Quotient (IQ) and Electroencephalography (EEG) Activity.

Latar Belakang: Pengobatan ARV meningkatkan usia harapan hidup anak dengan human immunodeficiency virus (HIV). Mayoritas anak dengan HIV memiliki masalah fungsi susunan saraf pusat (SSP) dan neurokognitif. Disfungsi serebri di SSP dapat dideteksi dengan pemeriksaan EEG. Gangguan fungsi SSP dan neurokognitif perlu dimonitor secara jangka panjang. Tujuan: Mengetahui perubahan IQ dan EEG pada pasien HIV anak yang telah memperoleh ARV. Desain: Sebuah penelitian kohort retrospektif pada anak dengan HIV berusia 7-17 tahun yang telah memperoleh ARV pasca follow-up dalam 3 tahun di bulan Februari hingga Maret 2018. Subyek berobat di Poliklinik Alergi dan Imunologi Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo (IKA RSCM). Dilakukan anamnesis penyakit infeksi SSP, jenis ARV, jenis sekolah, keteraturan minum ARV, stadium klinis HIV, tes IQ, dan EEG. Penilaian keteraturan minum ARV menggunakan kuesioner pengukuran dari Steel. Tes IQ menggunakan instrumen Wechsler intelligence scale for children (WISC). Nilai IQ dianggap normal bila IQ>80. Interpretasi EEG dinilai oleh konsultan saraf anak. Gambaran perlambatan umum dinilai abnormal pada EEG. Selanjutnya, dinilai perubahan proporsi IQ dan EEG normal serta hubungan perubahan IQ dengan stadium klinis HIV, penyakit infeksi SSP, jenis ARV, keteraturan minum ARV, dan jenis sekolah. Hasil: Jumlah subyek penelitian sebanyak 63 anak. Perubahan rerata skor verbal dan performance IQ adalah penurunan 8,22 (IK95% 5,55 – 10,90) dan penurunan 8,67 (IK95% 5,32-12,01) sedangkan perubahan nilai median full-scale IQ dari 87 (46-117) menjadi 79 (30-104). Terdapat perbedaan bermakna nilai IQ pada verbal, performance, dan full-scale IQ (p 80. The interpretation of EEG activity was evaluated by a child neurology consultant. Generalized slow EEG activity was considered abnormal. Furthermore, we evaluated changes in IQ proportion, normal EEG activity and the correlation between altered IQ and clinical stages of HIV infection, CNS infection, types of ARV, medication adherence to ARV treatment and types of school. Results: The number of subjects in our study was 63 children. Changes in mean score of verbal and performance IQ were 8.22 reduction (95%CI 5.55 – 10.90) and 8.67 reduction (95%CI 5.32-12.01); while the median value of full-scale IQ score altered from 87 (46-117) to 79 (30-104). There were significant differences in IQ scores including the verbal, performance and full-scale IQ scores (p < 0.001). There was an altered proportion of IQ score from normal into abnormal for verbal scale, performance and full scale scores, which occurred in 13 (20.6%), 12 (19%), and 10 (15.9%) subjects, respectively; There was a significant difference on altered proportion of IQ score, particularly on verbal score (p=0.002), performance score (p=0.035) and full-scale IQ score (p=0.039). The altered IQ proportion (verbal, performance and full-scale IQ score) had no correlation with stages of HIV infection (p=0.731), CNS infection (p=1.000), medication adherence to ARV treatment (p=0.831) and type of school (p=0.521). The altered proportion of EEG activity from normal category into abnormal was found in 19 (30.2%) subjects. There was a significant difference on altered EEG proportion (p=0.003). Conclusion: Long-term antiretroviral treatment does not improve the IQ score and EEG activity in HIV-infected children.
Keywords: HIV-infected children, antiretroviral treatment, intelligence quotient (IQ), electroencephalography