PERUBAHAN KADAR HEMOGLOBIN PASIEN BARU TERDIAGNOSIS HIV SEBELUM DAN SESUDAH TERAPI KOMBINASI ANTIRETROVIRAL

HAMZAH M HAFIQ, dr. Umi Solekhah Intansari, Sp. PK(K)., M.Kes.; dr. Teguh Triyono, Sp. PK., M.Kes.

2016 | Skripsi | S1 PENDIDIKAN DOKTER

Latar Belakang: Anemia merupakan kelainan hematologis yang paling sering terjadi pada pasien terinfeksi HIV. Kausanya mulitfaktorial dan menyulitkan diagnosis banding dan pengobatan yang memadai. Proporsi anemia yang timbul akibat pengobatan ARV cukup tinggi. Beberapa laporan mendokumentasikan senyawa lamivudine dapat menurunkan kadar hemoglobin. Besarnya proporsi anemia pada penduduk Indonesia menambah kekhawatiran mengenai kenaikan mortalitas dan penurunan kepatuhan pasien terkait terapi kombinasi ARV. Tujuan: Mengkaji perubahan kadar hemoglobin pasien baru terdiagnosis HIV selama terapi kombinasi ARV. Metode: Penelitian ini menganalisis kadar hemoglobin 28 pasien baru terdiagnosis HIV yang memperoleh terapi kombinasi ARV selama 6 di Rumah Sakit Sardjito dan Karyadi. Darah pasien diambil sebanyak 6 mL dari vena dan diberi anti-koagulan EDTA. Kadar hemoglobin dideteksi dengan menggunakan Automatic Hematology Analyzer. Analisis Independent-Samples T Test dan One-Way ANOVA digunakan untuk mengetahui perbedaan antara karakteristik dasar terhadap kadar hemoglobin. Paired-Samples T Test digunakan untuk mengetahui perbedaan antara kadar hemoglobin sebelum dan sesudah terapi. Hasil: Pengobatan ARV meningkatkan kadar hemoglobin pasien sebesar 0,64 g/dL (p = 0,001). Sebanyak 23 pasien (82,1%) tidak menderita anemia dan 5 pasien (17,9%) menderita anemia ringan. Stadium klinis (p = 0,290) dan tipe ARV (p = 0,807) tidak memiliki perbedaan pada kadar hemoglobin sesudah terapi, namun jenis kelamin (p = 0,001) dan usia (p = 0,042) memiliki perbedaan. Kesimpulan: Terdapat perubahan kadar hemoglobin pasien baru terdiagnosis HIV sebelum dan sesudah terapi kombinasi antiretroviral selama 6 bulan yang secara statistik bermakna, meskipun secara klinis tidak.

Background: Anemia is the most common hematological abnormality in HIV-infected patients. Its cause is multifactorial and could complicate adequate differential diagnosis and treatment. Anemia proportion as consequences of ARV treatment was quite high. Several report documented lamivudine decreases hemoglobin concentration. The high proportion of anemia among Indonesian generated concern regarding mortality and patient adherence related to adverse effect of ARV. Objective: Analyze the change of hemoglobin concentration in ARV therapy of newly diagnosed HIV patients. Methods: This research analyze hemoglobin concentration of newly diagnosed HIV patients after 6 month treatment course using ARV combination in Sardjito and Karyadi general hospital. Patients� blood was draw as many as 6 mL from vein and added EDTA as anticoagulant. Hemoglobin concentration was detected using Automatic Hematology Analyzer. Independent-Samples T Test and One-Way ANOVA were used to know the differences between variables toward hemoglobin concentrations. Paired-Samples T Test were used to know the difference of hemoglobin concentration before and after therapy. Results: ARV treatment increased 0.64 g/dL in hemoglobin concentration (p = 0.001). As many as 23 patients (82.1%) were non anemic and 5 patients (17.9%) suffered mild anemia. Clinical stage (p = 0.290) and type of ARV (p = 0.807) did not have differences to hemoglobin concentration after therapy. However, gender (p = 0.001) and age (p = 0.042) had statistically significant differences. Conclusion: There was statistically significant change in hemoglobin concentration of newly diagnosed HIV patients after 6 month treatment of antiretroviral combination, although its change was not clinically significant.

Kata Kunci : anemia, hemoglobin, antiretroviral, lamivudine / anemia, hemoglobin, antiretroviral, lamivudine