The Patterns of Primary Cotrimoxazole Prophylaxis in Adult HIV Patients in HIV Integrated Clinic Cipto Mangunkusumo Hospital Jakarta in 2004-2013 Ken Ayu Mastini 1 , Zubairi Djoerban 2 , Evy Yunihastuti 3 , Hamzah Shatri 4 1 Internal Medicine Department, Faculty of Medicine University of Indonesia, 2 Medical Hematology and Oncology Division, 3 Allergy and Clinical Immunology Division, 4 Psychosomatic Division, Internal Medicine Department, Faculty of Medicine University of Indonesia
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The Patterns of Primary Cotrimoxazole Prophylaxis in Adult HIV Patients in HIV Integrated Clinic Cipto
Mangunkusumo Hospital Jakarta in 2004-2013
Ken Ayu Mastini1, Zubairi Djoerban2, EvyYunihastuti3, Hamzah Shatri4
1Internal Medicine Department, Faculty of Medicine University of Indonesia, 2Medical Hematology and Oncology Division, 3Allergy and
Clinical Immunology Division, 4Psychosomatic Division, Internal Medicine Department, Faculty of Medicine University of Indonesia
Background
• Cotrimoxazole is standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis patients.
Guideline on Cotrimoxazole Prophylaxis for HIV Related Infections Among Children, Adolescents and Adults. WHO;2006. AmmannAJ. HIV Ther. 2009;3:329–38. Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral pada Orang
Dewasa.Kementerian Kesehatan Republik Indonesia, 2011. Yunihastuti E, dkk. Infeksi Oportunistik pada AIDS. Jakarta:BalaiPenerbit FKUI;2005. Church JA. Lancet Infect Dis. 2014;14:892-8 Zachriah R, Harries AD, Luo C. Lancet Infect Dis. 2007;7:686–93.
International Standards for Tuberculosis Care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance, 2006.
Objective
• To know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazoleprophylaxis in adult HIV patients
Methods
• Cohort retrospective study in HIV Integrated Clinic Cipto MangunkusumoHospital
Study Design
• All patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis
Study Subjects
Results
• 3818 patients had indication of primary cotrimoxazole prophylaxis
•Not discontinue when finish TB drugs 200% (RIK 25%)
CTX discontinuation in those who did not
have adverse event (N= 908)
CTX Duration Based On CD4
Initial CD4 Duration p value
≤ 100 21 months (IQR 22) p <0.001
> 100 12,5 months (IQR 14,75)
Median duration was 20 months (IQR 20)
Conclusion
• Although initiation of primary cotrimoxazoleprophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline