INFEKSI HUMAN IMMUNODEFICIENCY VIRUS, TUBERKULOSIS PARU, HIPERTENSI PULMONAL, DAN GIZI KURANG

Vina Wira, dr.Eggi Arguni,M.Sc,Ph.D,Sp.AK; Dr.Med.dr. Intan Fatah Kumara,M.Sc,Sp.AK

2020 | Tesis-Spesialis | ILMU KESEHATAN ANAK

Pasien anak dengan infeksi human immunodeficiency virus (HIV) berpotensi mengalami kejadian, rawat inap berulang, gangguan pertumbuhan dan perkembangan, rendahnya kualitas hidup, dan kematian. Tujuan pengamatan dan pemantauan secara longitudinal adalah untuk mengamati beberapa faktor-faktor yang dapat memengaruhi keberhasilan terapi seperti kejadian infeksi oportunistik (infeksi tuberkulosis (TB) paru), kelengkapan imunisasi, kepatuhan terapi dan mencegah terjadinya permasalahan seperti komplikasi penyakit dan efek samping terapi. Pasien perempuan berusia 12 tahun 9 bulan datang dengan keluhan demam lama, batuk, penurunan berat badan, diare, sariawan, dan sesak napas. Pasien didiagnosis dengan infeksi HIV, TB paru, hipertensi pulmonal, dan gizi kurang. Pemantauan dilakukan hingga pasien berusia 16 tahun 8 bulan dengan hasil perbaikan pertumbuhan, infeksi TB paru yang telah sembuh, tidak terdapat infeksi oportunistik yang berat, tidak ada rawat inap berulang, peningkatan kadar CD4 dan turunnya jumlah viral load, terkendalinya kondisi hipertensi pulmonal, serta peningkatan kualitas hidup pasien, namun diketahui bahwa pasien mengalami keterlambatan perkembangan seks sekunder dan pubertas. Tatalaksana dengan terapi antiretroviral (ARV) dan obat anti tuberkulosis (OAT) telah diberikan, bersama dengan terapi sildenafil untuk tatalaksana hipertensi pulmonal. Kebutuhan nutrisi diberikan sesuai recommended dietary allowance (RDA). Pemantauan jangka panjang masih diperlukan terutama terkait kepatuhan, respon, dan efek samping terapi, rencana melengkapi imunisasi, dan evaluasi masalah gangguan perkembangan seks sekunder pada pasien.

Children with human immunodeficiency virus (HIV) infection have the potential problems such as rehospitalization, growth and development disorders, low quality of life, and mortality. The aim of this longitudinal observation is to monitor several factors that might be associated to successful of the treatment such as opportunistic infections (pulmonary tuberculosis), the incomplete immunization, the compliance of the treatment, and prevent the complications and side effects of the therapy. Female patient aged 12 years 9 months old presented with prolonged fever, cough, decrease of body weight, diarrhea, oral ulcer, and shortness of breath. She was diagnosed as HIV infection, pulmonary tuberculosis (TB), pulmonary hypertension, and wasted. The observation was performed until she was 16 years 8 months old with the results of body weight increment improvement, the pulmonary TB was fully recovered, there was no severe opportunistic infections, no rehospitalization, increased of CD4 level and undetected viral load, no complication of pulmonary hypertension, and increased of the quality of life, however she had a delayed in secondary sex development and puberty. The management of antiretroviral treatment (ART), anti tuberculosis drugs, and pulmonary hypertension drugs were given along with nutritional support based on recommended dietary allowance (RDA). It is still necessary to do the long term monitoring, especially to observe the compliance and side effects of the treatment, plan to complete the immuzation, and evaluate the disorder of secondary sex development toward this patient.

Kata Kunci : infeksi human immunodeficiency virus, tuberkulosis paru, hipertensi pulmonal, gizi kurang, anak