Terapi Antiretroviral pada HIV/AIDS

Terapi Antiretroviral pada HIV/AIDS

Afif Nurul Hidayati, Saut Sahat Pohan

Bagian/SMF Ilmu Kesehatan Kulit dan Kelamin,

FK UNAIR/RSU Dr. Soetomo,

Surabaya

Abstrak: Penemuan antiretroviral therapy (ART) yang poten mendorong revolusi perawatan penderita HIV/AIDS. Meskipun belum mampu menyembuhkan bahkan menambah tantangan dalam hal efek samping serta resistensi kronis terhadap obat, namun secara dramatis menunjukkan penurunan angka kematian dan kesakitan. Obat antiretroviral (ARV) menghambat replikasi Human Immunodeficiency Virus (HIV). Pemberian kombinasi beberapa obat ARV (highly active antiretroviral therapy/HAART) dapat menghambat replikasi HIV, memperlambat defisiensi imun, serta meningkatkan kualitas dan lama hidup penderita HIV. Karena pemilihan rejimen yang rumit, lamanya terapi, efek samping yang ditimbulkan, biaya yang besar, serta perlunya kepatuhan yang tinggi, maka perlu keterlibatan pasien dalam pemilihan terapi. Selain itu perlu mempertimbangkan keuntungan dan kerugian pemberian ARV pada penderita asimptomatik. WHO merekomendasikan bahwa pada sumber daya yang terbatas, pemberian ARV dimulai jika infeksi sudah ditegakkan dan memenuhi salah satu dari kriteria: penyakit HIV stadium IV menurut WHO, penyakit HIV stadium III menurut WHO dengan hitung sel TCD4+ <350/mm3, atau penyakit HIV stadium I/II menurut WHO dengan hitung sel TCD4+ <200/mm3. Jika pemeriksaan hitung sel TCD4+ tidak tersedia maka pemeriksaan total lymphocyte count (TLC) kurang dari atau sama dengan 1200/mm3 dapat digunakan sebagai dasar pemberian terapi.

Kata kunci: siklus replikasi HIV, sel TCD4+, TLC, NRTIs, PIs.

Abstract: The advent of potent antiretroviral therapy (ART) led to a revolution in the caring the HIV/AIDS patients. Eventhough there is no treatment absolutely improving the disease and there are still challenges in the side-effects and the resistance of medicines, but it has been found a decrease in morbidity and mortality of it and an improvement of guality of life of people with HIV/AIDS. It had been proved that ARV drug inhibit the replication of HIV. When ARV drugs are given as combination drugs (highly active antiretroviral therapy/HAART), HIV replication and immune deterioration can be delayed, therefore, survival and quality of life can be improved. However, due to the complexity in selecting the regimen, the severity of the side effects, the treatment costs, and the patients’ compliance, it is important to involve the patients select the therapy. It has been considered the advantages and disadvantages of the HIV/AIDS patients treatment when the patients haven’t symptoms. WHO recommends that in source-limited settings, HIV-infected patients should start ARV therapy when the infection has been confirmed and one of the several conditions such as WHO stage IV HIV disease, WHO stage III HIV disease with CD4+T cells <350/mm3, or WHO stage I/II HIV disease with CD4+T cells <200/mm3 are present. In cases, when CD4+T cells cannot be assessed, the presence of total lymphocyte count (TLC) of 1200/mm3 or below can be used as a substitute indication for treatment.

Keywords: replication cycle of HIV, CD4+T cells, TLC, NRTIs, PIs

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