Highly active antiretroviral therapy adherence and its determinants in selected regions in Indonesia.

Background: Highly active antiretroviral therapy (HAART) can reduce morbidity and mortality of HIV-infected patients. However, it depends upon adherence to medication. The objective of this study was to examine the adherence to HAART and to evaluate individual patient characteristics i.e. self-efficacy, depression level, and social support and to finally determine HAART adherence in selected regions in Indonesia. Methods: This cross-sectional study was conducted in Jakarta, Malang, Bandung, Makasar and Banda Aceh. The subject of the study was HIV-infected patients who were older than 13 years old and had taken HAART for at least a month. They were recruited consecutively then asked how many pills they had missed during the previous month. Poor adherence can be stated if the percentage of adherence rate is below 95%. HIV treatment adherence self-efficacy scale (HIVASES), Beck Depression Inventory (BDI-II) and Interpersonal Support Evaluation List (ISEL) was adapted to assess self-efficacy, depression level and social support, respectively. Results: We found that 96% (n=53) of the subjects adhered to HAART. There were no associations between adherence with self-efficacy, depression level, and social support. The main cause of non-adherence in this study was ‘simply forget’. Conclusion: Adherence to HAART was found to be high and not associated with self-efficacy, depression level and social support in some central regions in Indonesia.

Development of multiplex-PCR assay for rapid detection of Candida spp.

Aim Candida spp. infection commonly occur in immunocompromised patients. Biochemical assay for identifi cation of Candida spp. is time-consuming and shows many undetermined results. Specifi c detection for antibody, antigen and metabolites of Candida spp. had low sensitivity and specifi city. In this study, we developed a rapid diagnostic method, Multiplex-PCR, to identify Candida spp. Methods Five Candida spp. isolates were cultured, identifi ed with germ tube and API® 20 C AUX (BioMerieux® SA) kit. Furthermore, DNA was purifi ed by QIAamp DNA mini (Qiagen®) kit for Multiplex-PCR assay. Results DNA detection limit by Multiplex-PCR assays for C. albicans, C. tropicalis, C. parapsilosis, C. krusei and C. glabrata were 4 pg, 0,98 pg, 0,98 pg, 0,5 pg and 16 pg respectively. This assay was also more sensitive than culture in that Multiplex-PCR could detect 2.6-2.9 x 100 CFU/ml, whereas culture 2.6-2.9 x 102 CFU/ml. Conclusion Multiplex-PCR is much more sensitive than culture and thus, can be recommended as a sensitive and specifi c assay for identifi cation of Candida spp.

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.

Correlation between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/ AIDS patient.

AIM: To know the correlation between CD4 count and intensity of Candida colonizations in the oropharynx of HIV-infected/AIDS patients, to get the prevalence of oropharyngeal candidiasis (OPC), and to know what kind of Candida species that causes oropharynx candidiasis of HIV-infected/AIDS patients. METHODS: A cross-sectional study was conducted in HIV-infected/AIDS patients who came as outpatients and inpatients in Cipto Mangunkusumo Hospital. The patients were interviewed, physically examined, their CD4 counts were checked, and their mouth rinse samples were taken to be cultured. Candida species was identified in CHROMagar media, and data were processed. RESULTS: From September 2004 until January 2005, 60 HIV-infected/AIDS patients were included in this study. There were 86.7% males and 13.3% females. Majority of the patients were from 20-30 years age group (85%). The most frequent transmission was among drug users (75%) followed by sexual contact (18.3%). The median of CD4 counts was 100 cells/il, ranged from 2 to 842 cells/il. Proportion of the OPC was 63.3% (CI 95% = 51.1 - 75.5). From 59 Candida isolates in this study, 74.58% were C. albicans. Candida non C. albicans species that were found in this trial were C. krusei, C. parapsilosis and C. tropicalis. There was significant correlation between low CD4 counts and high intensity of Candida colonization on the oropharynx of the subjects (r = -0.756). CONCLUSION: There was strong negative correlation (r = -0.756) between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/AIDS patients. Proportion of OPC in this study was 63.3%. The most frequent species found in the oropharynx of the subjects was C. albicans.

Interleukin-18 levels in adult dengue fever and dengue hemorrhagic fever.

Interleukin (IL)-18 ( interferon-γ inducing factor) is one of cytokines, produced by macrophage, take part in differentiation T-helper (Th) to Th1 and interferon γ producing. T helper1 play role in cellular immunity especially in viral infection include dengue. A descriptive correlative study has done to know the correlation between IL-18 levels and disease severity in admitted dengue fever (DF) and dengue hemorrhagic fever (DHF) patients. In 42 subjects consist of 20 (47.6%) DF and 22 (53.3%) DHF (grade I to IV WHO criteria, 1999) showed that IL-18 levels significantly higher in DHF than DF patients. There are significant correlation between IL-18 levels and hematocrit and low platelet value. This study supports the possible role of IL-18 in pathogenesis DHF in adults.