Breast-conserving treatment versus mastectomy in T1-2N0 breast cancer: which one is better for Indonesian women.

Background: This study aimed to compare the treatment outcomes between the use of breast-conserving treatment (BCT) and mastectomy for T1-2N0 breast cancer patients. Methods: This study retrospectively reviewed T1-2N0 breast cancer patients who received treatment between January 2001 and December 2010 at Department of Radiotherapy Cipto Mangunkusumo Hospital and Jakarta Breast Center. The endpoints of this study were overall survival (OS), local recurrence (LR), contra-lateral breast cancer (CBC), distant metastasis (DM), and disease-free survival (DFS). Results: Among the 262 eligible patients, 200 (76.3%) patients underwent BCT while 62 (23.7%) patients underwent mastectomy. There were no differences between BCT and mastectomy groups in 5-Y OS (88.2% vs 86.7%, p = 0,743), LR (7.4% vs 2.7%, p = 0.85), CBC (3.4% vs 5.3%, p = 0.906), DM (17.7% vs 37.7%, p = 0.212), and DFS (78.5% vs 60.7%, p = 0.163). In multivariate analysis, grade 3 was associated with worse OS (HR 2.79; 95% CI 1.08 – 7.21, p = 0.03) and DFS (HR 2.32; 95% CI 1.06 – 5.06). Premenopausal women were associated with decreased risk of DM (HR 0.37; 95% CI 0.17 – 0.80) and DFS (HR 0.38; 95% CI 0.19 – 0.78). Conclusion: BCT and mastectomy showed similar outcome in terms of OS, LR, CBC, DM, and DFS.

Clinical manifestations and antiretroviral management of HIV/AIDS patients with tuberculosis co-infection in Kramat 128 Hospital.

AIM: to give a description of HIV-AIDS and tuberculosis co-infection in Jakarta, viewed from the perspective of virologic and immunologic status and the correct selection of antiretrovirals. METHODS: cross-sectional descriptive study was performed on the outpatient clinic of Kramat 128, from June to July 2007. Tuberculosis infection was confirmed chest X-ray or sputum acid fast smear. Viral load was determined by Polymerase Chain Reaction (PCR) and CD4 count done by flow cytometry. The data were then analyzed using SPSS 14th and Chi Square tests for proportional data. RESULTS: the study enrolled 130 patients with the prevalence of tuberculosis co-infection of 66.9% (n=87). The TB co-infected patients came with more clinical manifestations (3-4 manifestations) than the non co-infected ones (2-3 manifestations; p<0.001). They also underwent more hospitalizations (44.8% vs. 11.6%, p=0.003), had lower CD4 levels (126.49 cell/microL vs. 240.68 cell/microL; p=0.001) and more patients with CD4 levels of below 100 cell/microL (64.6% vs. 25.6%; p<0.001). The co-infected patients had more virologic failure than the non co-infected ones (38% vs. 12.5%; p=0.030), and so did the co-infected patients treated with nevirapine than those treated with efavirenz (37.8% vs. 6.3%; p=0.019). CONCLUSION: tuberculosis co-infection complicated the clinical management of People Living with HIV-AIDS (PLWHA) and the antiretroviral regimen selection in these patients need to be modified. Subsequent studies were needed to confirm this study result of superior efavirenz based therapy in the TB co-infected PLWHA.

Quality of life of HIV patients and influential factors.

AIM: To identify quality of life in HIV patients and to investigate associated factors. METHODS: A cross-sectional comparative study of HIV patients visiting the outpatient clinic at Cipto Mangunkusumo National Central Hospital and Dharmais Cancer Hospital was conducted between March and June 2003. Subjects were patients willing to fill in the SF-36 questionnaire, and willing to undergo physical examination and laboratory tests. Multivariate analysis was performed to identify the determinant factors that dominantly affect the quality of life in HIV patients. RESULTS: From 107 HIV subjects, we found poor quality of life. The score of HIV patients' quality of life components was as follows: mean physical function 49.2, social function 46.4, limitations due to physical factor 43.2, limitations due to emotional factor 48.8, mental health 50.7, energy 48.8, pain 54.7 and general health 42.7. The mean quality of life score for physical components in HIV patients was 47.45 while the mean quality of life score for mental components was 48.075. Factors that dominantly contribute to the quality of life in HIV patients are, respectively, the presence of opportunistic infection (p=0.001 OR=5.297 CI 1.974-14.218) and ARV therapy for more than 3 months (p=0.048 OR=4.487 CI 1.011-19.908). CONCLUSION: Both physical and mental components in HIV patients demonstrated poor quality of life. Factors that dominantly contribute to the quality of life in HIV patients are, the presence of opportunistic infection and ARV therapy for more than 3 months.

Viral load profiles in drug users with asymptomatic HIV infection and normal CD4 cell counts.

Since the year 2000 there has been a steep increased in the number of HIV/AIDS patients in Indonesia, coming mostly from intravenous drug users. Antiretroviral treatment has been proved to decrease mortality and increase quality of life of HIV/AIDS patients. The treatment is given according to clinical condition of the patients, number of CD4 and viral load. In this study, CD4 and viral load were examined in 71 asymptomatic HIV patients originated from injecting-drug users. CD4 counting was performed by indirect immunoflouresence method using monoclonal antibody, and viral load was tested using PCR technique. Among 56 patients who has the number of CD4 more than 200/mm3, 30 patients (55.4 %) has viral load more than 55,000 copies/ml and 35.7% has viral load 5,000-55,000 copies/ml. Correlation between the number of CD4 and viral load gave the r value of 0.194. It is concluded that there is no association between the number of CD4 and viral load in drug user HIV/AIDS patients. The treatment of HIV/AIDS for these patients should be given according to the viral load.