INFEKSI HUMAN IMMUNODEFICIENCY VIRUS, PNEUMOCYSTIS JIROVECI PNEUMONIA DAN GIZI KURANG

YOKE KINANTHI PUTRI, dr. Dwikisworo Setyowireni, SpA(K).; dr. Eggi Arguni, M.Sc., Ph.D, SpA

2017 | Tesis-Spesialis | SP ILMU KESEHATAN ANAK

Seorang anak laki-laki usia 6,5 tahun didiagnosis infeksi HIV stadium III (selama 4 tahun), pernah beberapa kali dirawat karena infeksi pneumocystis jiroveci pneumonia dan didiagnosis infeksi TB yang membaik dengan terapi. Saat ini status gizi kurang. Sebelumnya ada riwayat putus obat ARV selama 10 bulan pada awal terapi akibat faktor sosial dan ekonomi. Ayah dan ibu juga penderita infeksi HIV dan telah menjalani terapi. Saat awal pemantauan status imunologis anak dengan kadar CD4 13sel/mm 3 (CD4 + 2%) masuk kategori imunodefisiensi berat. Setelah dilakukan pemantauan, pendampingan dan intervensi intensif selama 18 bulan, terdapat perbaikan status imunodefisiensi dengan kadar CD4 935 sel/mm kg/m 2 3 + (tidak ada imunodefisiensi). Status gizi membaik dengan IMT 11,8 saat awal pengamatan menjadi 16,8 kg/m 2 (IMT/U -2SD < z < 2 SD). Skor Pediatric Symptomps Checklist-17 (PSC 17) > 15 menunjukkan tidak ada gangguan psikosial. Selama pemantauan tidak ditemukan efek samping obat ARV maupun infeksi oportunistik. Skor PedsQL 43,75-80% meningkat menjadi 85-90% menunjukkan perbaikan kualitas hidup. Edukasi tentang kebersihan dan kesehatan lingkungan hidup melalui kunjungan rumah juga memperbaiki kualitas lingkungan. Simpulan: Keberhasilan terapi dapat dicapai dengan pemantauan, pendampingan dan intervensi intensif baik terhadap pasie n maupun anggota keluarga. Kondisi psikosial dan lingkungan juga dapat diperbaiki dengan pendampingan dan supervisi petugas kesehatan.

A 6.5-year-old boy diagnosed with stage III HIV infection (since 4 years ago) has been hospitalized for several times due to pneumocystis jiroveci pneumonia infection and was diagnosed with TB infection which recovered with therapy. The child was in mild to moderate malnutrition. Previously there was a history of drop off of antiretroviral (ARV) theraphy for 10 months due to social and economic factors. Father and mother are also live with HIV infection and have taken ARV therapy. At the beginning of the observation the child had CD4 (CD4 + 2%) and categorized as severe immunodeficiency. After 18 months of intensive monitoring, counseling, and intervention, there was an improvement in immunodeficiency status with CD4 + levels rising to 935 cells/mm3 (no immunodeficiency). Nutritional status improved with BMI 11.8 kg/m2 at the beginning of observation to 16.8 kg/m 2 (IMT / U -2SD <z <2 SD). Pediatric Symptomps Checklist-17 (PSC 17) > 15 score indicates no psychosocial disorder. During the observation there were neither side effects of ARV drugs nor opportunistic infections. PedsQL score was 43.75-80% increased to 85-90%, showed improvement of quality of life. Education on hygiene and environmental health in form of home visits also improves the quality of the environment. Conclusions: The success of therapy can be achieved by monitoring, counseling and intensive intervention to patients and family members. Psychosocial and environmental conditions can also be improved with the assistance and supervision of health workers.

Kata Kunci : infeksi HIV, imunodefisiensi, putus obat, terapi, kualitas hidup, HIV infection, immunodeficiency, poor adherence, therapy, quality of life