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Peranan Laboratorium dalam Prevention of Mother to Child Transmission (PMTCT) HIV Sri Ratna Dewi; Umi S. Intansari
WMJ (Warmadewa Medical Journal) Vol 2 No 1 (2017): Mei 2017
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.2.1.74.33-43

Human Immunodeficiency Virus (HIV) adalah retrovirus RNA yang dapat menyebabkan penyakit klinis, yaitu Acquired Immunodeficiency Syndrome (AIDS). Transmisi virus dari ibu ke anak (mother to child transmission/MTCT) dapat terjadi melalui darah maternal, sekresi saluran genital, dan ASI. Risiko penularan HIV dari ibu ke bayi dapat ditekan hingga 2% dengan program PMTCT. Tulisan ini bertujuan untuk memaparkan tentang peran laboratorium dalam mendukung program PMTCT HIV. Dalam hal ini laboratorium memegang peranan yang penting dalam mendeteksi HIV secara dini dan diikuti dengan evaluasi. Untuk menentukan bayi tidak mengidap HIV, diperlukan minimal dua kali pemeriksaan polymerase chain reaction (PCR) RNA HIV dengan hasil negatif, yaitu pada usia 4-6 minggu dan pada usia 4-6 bulan. Pada saat bayi berusia 18 bulan dilakukan pemeriksaan antibodi terhadap HIV dengan cara Enzyme-linked Immunosorbent Assay (ELISA) untuk konfirmasi. Laboratorium memegang peranan penting dalam melakukan deteksi dini HIV serta membantu dalam proses follow up sehingga dapat mendukung program PMTCT. Kata kunci: PMTCT, HIV, PCR, ELISA [Laboratory Role In The Prevention of Mother to Child Transmission (PMTCT) of HIV]The Human Immunodeficiency Virus (HIV) is a RNA retrovirus which causes the clinical disease termed the acquired immunodeficiency syndrome (AIDS). Mother-to-child transmission (MTCT) may occurred because of the intrapartum maternal blood exposure, infected genital tract secretions and during breastfeeding. The aim of this paper is to explain the role of laboratory to support PMTCT program. Laboratory plays an important role in PMTCT, that given the starting point of PMTCT is early detection of HIV and followed by evaluation. To determine the baby does not have HIV, it takes at least two times the HIV RNA PCR with negative results, (at 4-6 weeks of age and at the age of 4-6 months). And then infants examined for HIV antibodies by Enzyme-linked Immunosorbent Assay (ELISA) for confirmation at 18-month-old. Laboratory has an important role to support diagnose of HIV and their follow up, so it can be support PMTCT program.Keywords: PMTCT, HIV, PCR, ELISA

FCγII (CD32) MONOSIT DI INFEKSI DENGUE PRIMER DAN SEKUNDER {FcγRII (CD32) Monocytes in Primary and Secondary Dengue Infection} Umi S. Intansari; Usi Sukorini; Shanti Ika Sari
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 22, No 1 (2015)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v22i1.1221

Dengue infection is a major health problem in the world, including Indonesia. Clinical manifestations of dengue infection varywidely, from asymptomatic until dengue shock syndrome (DSS). Antibody Dependent Enhancement (ADE) hypothesis that states thatnon-neutralizing antibodies in secondary dengue infection may enhance dengue infection via Fcγ receptors is still controversial. Clinicalresearch shows that not all secondary infections manifest as DHF/DSS, but nearly all DHF/DSS cases are caused by secondary infection.Allegedly, the expression of Fcγ has an effect on this incident. This study is an observational analytical study with a cross sectional designto determine the expression of FcγRII (CD32) monocytes in patients with primary and secondary dengue infection. CD32 of monocyteswas measured using FACS Calibur with lyse no wash technique. Primary and secondary dengue infection were determined by IgM/IgGoptical density ratio using ELISA capture method. The ratio of IgM/IgG ≥1.2 was considered as primary infection, while the ratio <1.2was considered as secondary infection. Twenty primary and 32 secondary dengue infection patients in acute phase of dengue infectionpartisipated in this study. Expressions of Fcγ RII (CD32) monocytes were significantly lower in primary than secondary dengue infection(187.825±31.584 vs 218.598±43.414 MFI; p=0.008). CD32 expressions were higher in day 3 compared to day 4 of fever.

PERAMALAN SEPSIS AKIBAT PROCALCITONIN TERKAIT KELUARAN HASIL KLINIS Umi S. Intansari; Nunung Dartini; Kismardhani Kismardhani
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 20, No 2 (2014)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v20i2.1078

Sepsis is a systemic inflammatory response due to a severe infection. The systemic immune response rises after the local immuneresponse does not successfully eliminate the antigen. Procalcitonin (PCT) has been known as the marker for bacterial infection. The aimof this study was to know whether PCT could be used as a predictor of clinical outcome in sepsis incidence. A prospective cohort designwas used in this study. The subjects were patients entering the Internal ward who met the inclusion and exclusion criteria and examinedfor the basic data collection. For the assessment of SOFA (Sepsis-related Organ Failure Assessment) score, blood specimens were takenfor PCT examination, on the first day since the diagnosis of sepsis and on the third day. The patients were observed until the tenth dayto determine the assessment of their survival analysis. This study involved 50 subjects who fulfilled the inclusion and exclusion criteria.The mean levels of PCT on day I and III were 5.19±5.83 ng/mL and 6.37±9.85 ng/mL, respectively. The mean levels of PCT on day I andIII in the group with increased SOFA score was 5.01±1.17 ng/mL and 3.86±1.46 ng/mL, respectively. The mean levels of PCT on day Iand III in the group without increased SOFA was 5.32±1.21 ng/mL and 4.88±2.21 ng/mL, respectively. The relative risk of increasedPCT against the poor output expressed by the increased SOFA score was 5.75. In the survival analysis, it was shown that 52% of patientssurvived at day 10. In the group of non survival patients; the number of patients with increased PCT was more than that without increasedPCT. Based on this study, it can be concluded that procalcitonin could be used as a predictor for the clinical outcome in sepsis patients.

, DALAM KEADAAN (STATUS) IMUNOLOGIS DAN KLINIS PENGOBATAN ANTIRETROVIRAL PENDERITA HIV/AIDS CD38 LIMFOSIT CD8 + , TAMPANG (PROFIL) CD4 + Ira Puspitawati; Umi S. Intansari
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 16, No 1 (2009)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v16i1.994

ABSTRACTThe relationship between immune activation and pathogenesis of Human Immunodeficiency Virus (HIV) infection is unproven. It has been hypothesized that state that HIV-induced activation enhances the magnitude of HIV replication other study shown that viralreplication impaired immune activation. One of the best immune activation marker is CD38 expression on CD8because it has thestrongest significant prognostic markers. It was previously shown that increased CD8+ T-cell activation has predictive value for diseaseprogression but the relation is still controversial. One hypothesis state that HIV-induced activation enhances the magnitude of HIVreplication, other said that viral replication impaired immune activation. To know the profile of immunology and clinical state of HIV/AIDS patients by determining the CD38 molecule expression on CD8+ profiles and clinical state.Crosssectonal, observasional study was done. Twenty nine HIV/AIDS patients who routinely had medical check up and having routine +cells as an activation marker, CD4+antiretroviral therapy at Sardjito hospital and 8 healthy people as normal controls were involved in this study. The count of CD4 +cells counts had significantnegative correlation with WHO stage (p = 0.012). Expression of CD38 molecule on CD8absolute counts and expression of CD38 molecule on CD8 cells were measured using flowcytometry. The CD4+cells of HIV/AIDS patients were highercompared to normal controls, 209.29 ± 76.56, 109.61 + 32.29 respectively (p < 0.05). That expression was not correlated with CD4 + +counts and CD4incrementafter therapy was statistically significant (p = 0.003). The CD4+increment. It might be caused by the time of measurement was not at the begining of diseases. The CD4 + count was negatively correlated with the WHO stage. Expression ofCD38 molecule on CD8+ cells of HIV/AIDS patients were significantly higher compared to normal controls but it wasn’t correlated withthe CD4++ number and CD4+increment after therapy.

VIROLOGICAL AND IMMUNOLOGICAL RESPONSE TO ANTIRETROVIRAL TREATMENT IN HIV-INFECTED PATIENTS (Respons Virologis dan Imunologis terhadap Pengobatan Anti-Retroviral di Pasien Terinfeksi HIV) Umi S. Intansari; Yunika Puspa Dewi; Mohammad Juffrie; Marsetyawan HNE Soesatyo; Yanri W Subronto; Budi Mulyono
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 23, No 1 (2016)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v23i1.1187

Infeksi HIV/AIDS masih menjadi tantangan global. Pengobatan antiretroviral (ART) berperan dalam menurunkan replikasi virus,menurunkan tingkat kematian infeksi oportunistik dan meningkatkan kualitas hidup orang yang hidup dengan HIV/AIDS. Meskipundemikian data terkait respons virologis dan imunologis termasuk aktivasi imun masih sangat terbatas. Penelitian ini bertujuan untukmengetahui respons virologis dan imunologis pasien HIV setelah 6 bulan memulai pengobatan ARV. Subjek dari penelitian observasionalprospektif ini adalah 44 pasien HIV yang belum pernah mendapat pengobatan ARV, yang berobat di RSUP Dr. Sardjito Yogyakarta danRSUP Dr. Kariadi, Semarang. Sampel darah EDTA sebanyak 6 mL diambil pra dan pasca 6 bulan pengobatan ARV untuk pemeriksaanjumlah sel T CD4+, kadar RNA HIV dan persentase sel T CD8+/38+. Kadar RNA HIV turun secara bermakna sejalan dengan persentasesel T CD8+/38+, sementara jumlah sel T CD4+ meningkat bermakna. Sebanyak 79,5% pasien mengalami pemulihan sel T CD4 optimal(>50 sel/μL) dan kadar RNA HIV turun lebih dari 1 log10 kopi/mL pada 93% pasien. Pasien dengan respons tidak sesuai antara virologisdan imunologis didapatkan sebanyak 13,6%. Kadar HIV bernasab positif dengan persentase sel T CD8+/38+ (r=0,58, p<0,0001) danbernasab negatif dengan jumlah sel T CD4+ (r=–0,470 (p<0,0001). Berdasarkan telitian ini, sebagian besar pasien mempunyai responsvirologis dan imunonologis yang sesuai 6 bulan setelah ART. Sebanyak 20,45% pasien tidak berespons atau mengalami ketidaksesuaianrespons virologis dan imunologis dan memerlukan penilaian dan pengobatan secara terus menerus.

PENGUKURAN JUMLAH LIMFOSIT CD4 METODE PANLEUCOGATING PADA PASIEN TERINFEKSI HUMAN IMMUNODEFICIENCY VIRUS (HIV) Umi S. Intansari; Budi Mulyono; Usi Sukorini
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 19, No 3 (2013)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v19i3.420

The standard method for absolute lymphocyte CD4 count is by the use of flow cytometric analysis, but due to the high costly matter,a simpler method and less costly fee of PanLeucogating dual platform is needed. The aim of this study is to know how to replace the single platform by PanLeucogating dual platform by determining the agreement between both methods and to test the proportion of patient who have CD4 <200 cell/ul measured by PanLeucogating and single platform method. A cross sectional study was carried out in the Departement of Clinical Pathology Faculty of Medicine Gadjah Mada University Yogyakarta. The inclusion criteria of the study are HIV/AIDS patients who their CD4 were measured. Absolute count of CD4 was using FACS Calibur measured with both PanLeucogating and single platform method. The bias, correlation, regression and limit of agreement between both methods were analyzed using Bland Altman analysis to decide whether the two methods are interchangeable. The result of the study revealed an excellent correlation between the two methods (r=0.996; y=- 0.906 + 0.0.987). Bland Altman analysis revealed bias=5 cells/uL; standard deviation=18.7 and Limit of agreement (LOA)=-31.6 – 40.75. The Mean Percentage Difference (MPD)=2%; dan%LOA=-7.96 – 12.5%. PanLeucogating method has a good agreement with the single platform method and can be used interchangeable. There was no difference of the proportion of patient who has CD4 <200 cell/ul measured by Panleucogating method and single platform.

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