Rudi Wisaksana
Departemen Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran, Rumah Sakit Dr. Hasan Sadikin Bandung

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Exploration of Methadone and HIV Treatment For Injecting Drug Users In West Java, Indonesia: Lessons from Practice Laere, Igor van; Hidayat, Teddy; Wisaksana, Rudi
Global Medical & Health Communication (GMHC) Vol 1, No 1 (2013)
Publisher : Fakultas Kedokteran Universitas Islam Bandung

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ABSTRACT Over the last decade, Indonesia became one of the fastest growing injecting drug user (IDU) driven HIV epidemics in Asia. Among strategies to prevent and control the HIV epidemic in Indonesia, methadone maintenance treatment (MMT) has been established and could become an entry point for HIV testing and treatment in IDUs. This study explored MMT and HIV treatment practices in West Java. An evaluation team visited six MMT clinics, interviewed staff and collected data on patient characteristics, methadone dose, and HIV testing and treatment practices. By October 2011, from 203 IDUs entering MMT (range 7-73 per clinic), 95% were male with the average age of 31 years (range 19-60 years), 92% had a senior high school or higher diploma, 47% had a regular income, and 55% were married. The mean methadone dose was 79 mg/day (range 13-208mg/day). About 85% of the MMT patients were tested for HIV, of whom 70% were found HIV positive (121/173), while 59% had a baseline CD4 count > 200 cells/mm3 and 65% were receiving ART.  In conclusion, few IDUs entered MMT in West Java and among those who did; high HIV and ART rates were reported, stressing the need for active linking between harm reduction services and integrated MMT and HIV treatment for IDUs.   Key words: injecting drug user; methadone; HIV; ART; clinical guideline; Indonesia
Nilai Mean Corpuscular Volume (MCV) Sebagai Petunjuk Ketaatan Minum Obat pada Penderita HIV Manullang, Rudolf Andean; Wisaksana, Rudi; Sumantri, Rachmat
Global Medical & Health Communication (GMHC) Vol 1, No 1 (2013)
Publisher : Fakultas Kedokteran Universitas Islam Bandung

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Abstrak Pengobatan Anti Retroviral (ARV) pada penderita HIV merubah secara dramatis prognosis penderita HIV tetapi memerlukan ketaatan pengobatan yang sempurna. Hingga saat ini penilaian ketaatan pengobatan ARV merupakan hal yang sulit dikerjakan karena ketiaadaan metoda penilaian yang ideal tetapi dapat digunakan sehari-hari diklinik. Pada makalah ini akan diutarakan mengenai peranan Mean Corpuscular Volume (MCV) sebagai metoda penilaian ketaatan pengobatan ARV pada penderita HIV.   Kata kunci: ARV, HIV, Ketaatan minum obat
Korelasi Jumlah CD4 Dan Total Lymphocyte Count (Tlc) pada Penderita HIV/AIDS dengan dan tanpa Terapi Antiretroviral Sulianto, Ivana Agnes; Indrati, Agnes R; Wisaksana, Rudi; Noormartany, Noormartany
Global Medical & Health Communication (GMHC) Vol 1, No 1 (2013)
Publisher : Fakultas Kedokteran Universitas Islam Bandung

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ABSTRAK Jumlah CD4 merupakan parameter laboratorium yang digunakan untuk memulai dan memantau terapi antiretroviral (ART) pada penderita HIV/AIDS. Namun pemeriksaan jumlah CD4 membutuhkan peralatan laboratorium yang mahal dan tenaga terlatih. World Health Organization (WHO) merekomendasikan total lymphocyte count (TLC) sebagai pengganti CD4 dalam memulai terapi. Penelitian ini bertujuan untuk melihat korelasi antara jumlah CD4 dan TLC pada data dasar, pemantauan pertama dan kedua penderita HIV/AIDS sebagai dasar digunakannya TLC untuk pemantauan terapi. Penelitian ini merupakan penelitian observasional analitik dan bagian dari penelitian kohort IMPACT (Integrated Management for Prevention And Care and Treatment of  HIV/AIDS) pada pasien HIV/AIDS di RS. Dr. Hasan Sadikin Bandung. Data tersebut dibagi menjadi kelompok tanpa ART dan dengan ART, masing-masing kelompok dibagi berdasarkan jenis kelamin. Analisis korelasi dilakukan pada data CD4 dan TLC dari tiap kelompok.Penelitian ini menggunakan 2239 data. Korelasi antara CD4 dan TLC pada data dasar pria tanpa ART adalah 0.644 (p=0.01), wanita tanpa ART adalah 0.74 (p=0.01), pria dengan ART 0.67 adalah (p=0.01), wanita dengan ART adalah adalah 0.601 (p=0.01). Korelasi antara CD4 dan TLC pemantauan pertama pria tanpa ART 0.56 (p=0.01), wanita tanpa ART adalah 0.606 (p=0.01), pria dengan ART adalah 0.569 (p=0.01), wanita dengan ART adalah 0.466 (p=0.01). Korelasi antara CD4 dan TLC pemantauan kedua pria tanpa ART adalah 0.697 (p=0.01), wanita tanpa ART adalah 0.306 (p=0.01), pria dengan ART adalah 0.556 (p=0.01), wanita dengan ART adalah 0.561 (p=0.01).  Kesimpulan :  terdapat korelasi yang baik antara jumlah CD4 dan TLC, sehingga TLC dapat digunakan sebagai alternatif pemantauan terapi sebelum penderita melakukan pemeriksaan CD4.   Kata kunci: CD4, HIV/AIDS, terapi antiretroviral, total lymphocyte count
Insidensi dan Karakteristik Hepatotoksisitas Obat Antituberkulosis pada Penderita Tuberkulosis dengan dan tanpa Infeksi HIV Sumantri, Agung Firmansyah; Djumhana, Ali; Wisaksana, Rudi; Sumantri, Rachmat
Global Medical & Health Communication (GMHC) Vol 3, No 2 (2015)
Publisher : Fakultas Kedokteran Universitas Islam Bandung

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Abstrak   Salah satu penyulit dalam pengobatan tuberkulosis (Tb) adalah hepatotoksisitas obat antituberkulosis (OAT). Pasien Tb dengan infeksi human immunodeficiency virus (HIV) meningkatkan risiko kejadian hepatotoksisitas OAT. Hal ini menjadi tantangan dalam menghadapi pasien Tb-HIV. Penelitian ini bertujuan mengetahui insidensi dan karakteristik penderita hepatotoksisitas OAT pada Tb dengan dan tanpa infeksi HIV. Penelitian ini adalah penelitian  epidemiologi  klinik  yang  bersifat  deskriptif  observasional.  Penelitian dilaksanakan di  ruang  rawat jalan dan rawat inap RSUP Dr. Hasan Sadikin (RSHS) Bandung serta ruang rawat jalan RS Bungsu periode Juni– Oktober 2012. Terdapat 120 subjek terdiri atas 18 penderita dengan infeksi HIV dan 102 penderita tanpa infeksi HIV. Mayoritas usia penderita Tb dengan infeksi HIV yaitu ≤35 tahun (17/18 penderita), laki-laki (12/18 penderita), indeks massa tubuh <18,5 kg/m2 (10/18 penderita), dan Tb paru (16/18 penderita). Penderita Tb dengan infeksi HIV yang mengalami hepatotoksisitas terhadap OAT lebih banyak daripada penderita Tb tanpa infeksi HIV (9/18 vs 19/102 penderita). Insidensi hepatotoksisitas OAT sebesar 23,3%. Hepatotoksisitas OAT pada penderita Tb dengan dan tanpa infeksi HIV terjadi pada 2 minggu pengobatan OAT dengan derajat ringan. Simpulan, insidensi hepatotoksisitas OAT pada penderita Tb dengan infeksi HIV lebih tinggi daripada tanpa infeksi HIV. Kata kunci: Hepatotoksisitas OAT, HIV, tuberkulosis   Incidence and Characteristics of Hepatotoxicity Anti-tuberculosis Drugs in Tuberculosis Patients with and without HIV Infection   Abstract Hepatotoxicity is one of the complications in the treatment of tuberculosis (Tb). Tuberculosis patient with HIV infection has higher risk in hepatotoxicity, and this is a clinical obstacle in dealing with Tb-HIV treatment. The aims of this study were to find the incidence and characateristic of anti-tuberculosis hepatotoxicity in tuberculosis patients with and without HIV infection. A descriptive observational study was conducted in outpatient/inpatient RSUP Dr. Hasan Sadikin (RSHS) Bandung, and outpatient RS Bungsu period June–October 2012. There were 120 Tb patients consisted of 18 patients with HIV and 102 patients without HIV. Most of Tb patients with HIV occured in age ≤35 years (17/18 patients), male (12/18 patients), body mass index <18.5 kg/m2 (10/18 patients), and pulmonal Tb (16/18 patients). Tb patients with HIV had hepatotoxicity more than without HIV (9/18 vs 19/102 patients). The incidence of hepatotoxicity was 23.3%. Hepatotoxicity anti-tuberculosis drugs in Tb patients with and without HIV infection mostly occured in second week therapy with mild degree. In conclusion, anti-tuberculosis hepatotoxicity is higher in TB patients co-infected with HIV than non-HIV infections. Key words: Anti-tuberculosis hepatotoxicity, HIV, tuberculosis
Oral manifestations of anemia in HIV/AIDS patients without ARV treatment Wisaksana, Rudi; Dewi, Tenny Setiani; Hidayat, Wahyu
Padjadjaran Journal of Dentistry Vol 29, No 1 (2017): March
Publisher : Faculty of Dentistry Universitas Padjadjaran, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (196.792 KB) | DOI: 10.24198/pjd.vol29no1.11752

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AbstractIntroduction: Acquired immunodeficiency syndrome (AIDS) is  a set of symptoms caused by decreases of the immune system that was infected by human immunodeficiency virus (HIV). Blood disorders often found in patient with HIV and associated with HIV infection. Mostly found disorders is anemia of chronic disease. The prevalence of anemia in HIV/AIDS patients reaches 70%. Oral manifestations of anemia are atrophy of the papillae on tongue, glossodynia, pallor, angular cheilitis, glossitis, aphthous ulcers/erosive lesions, candidiasis, and geographic tongue. There are many publications that uses anemia as indicator to determine the prognosis of HIV infection, thus the description of oral manifestation of anemia in the non-ARV HIV/AIDS patients is a necessity. The purpose of this study was to describe the oral manifestation of anemia in the non-ARV HIV/AIDS patients. Methods: The methods used were purposive random sampling. Samples were new HIV/AIDS patients who have not got antiretroviral (ARV) treatment. The study included 40 patients in Teratai Clinic Hasan Sadikin Hospital Bandung. Results: Oral manifestations of anemia were found amongst non-ARV HIV/AIDS patients, which were candidiasis in  37 patients, glossodynia in 28 patients, glossitis in 10 patients, and angular cheilitis in 1 patient. Conclusion: From the study found that oral manifestations of anemia that found in non-ARV HIV/AIDS patients were candidiasis, glossodynia, glossitis and angular cheilitis. HIV/AIDS patients with anemia needed to treat more intensive for better prognosis and quality of life.Keywords: Anemia, HIV/AIDS, Candidiasis, Glossitis, Glossodynia
Knowledge, Attitude and Practice towards Human Immunodeficiency Virus Infection among University Freshmen Students Year 2016/2017 Agustinawaty, Hervina; Lestari, Bony Wiem; Wisaksana, Rudi
Althea Medical Journal Vol 4, No 3 (2017)
Publisher : Althea Medical Journal

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Background: Human Immunodeficiency Virus (HIV) infection is one of the most serious public health and social problems in the world. Transmission of HIV occurs in the age group of 20 years or below. One of the ways to prevent HIV transmission is to improve the knowledge so the attitude and practice can be changed. The objectives of this study was to identify  the knowledge, attitude, and practice of HIV infection among university freshmen students year 2016/2017.Methods: This was a descriptive cross sectional quantitative study. Samples were selected using proportional random sampling and primary data were collected using questionnaires which were self-completed by 122 Universitas Padjadjaran freshmen students year 2016/2017 in November 2016. Questionnaire consisted of sociodemographic, knowledge, attitude, and practice data regarding to HIV infection. The collected data was analyzed dan presented in the form of tables and figure.Results: Respondents had a median age criterion of 18 years, 52.5% were female, 73.8% high school originated outside Bandung and 19.4% knew information about HIV/AIDS through the internet. There were 18.9% of the respondents classified as having “Good” knowledge, 63.9% classified as “Satisfactory” and the other 17.2% were classified as having “Poor” knowledge of HIV. There were 52.5% respondents who had negative attitude towards HIV discussion and 96.7% of the respondents had good practice.Conclusions: Lack of knowledge and negative attitude towards HIV infection and the presence of high risk practice for HIV infection demanded that students should receive reproduction health education to support the prevention of HIV infection. 
Gambaran Efek Samping dan Kepatuhan Terapi Antiretroviral pada Pasien HIV di Rumah Sakit Dr. Hasan Sadikin Bandung tahun 2015 Puspasari, Dewi; Wisaksana, Rudi; Rovina, Rovina
Jurnal Sistem Kesehatan Vol 3, No 4 (2018): Volume 3 Nomor 4 Juni 2018
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (323.97 KB) | DOI: 10.24198/jsk.v3i4.18495

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Jawa Barat berada dalam posisi 4 besar jumlah kasus baru infeksi HIV terbanyak di Indonesia selama 2012-2014. Pengidap HIV memerlukan terapi Antiretroviral (ARV) agar perkembangan penyakit, komplikasi dan penularannya dapat dicegah. Penelitian ini bertujuan untuk mengetahui gambaran efek samping dan kepatuhan terapi antiretroviral pada pasien HIV berbagai stadium. Penelitian ini merupakan penelitian deskriptif kuantitatif yang dilaksanakan pada September-November 2016. Data sekunder diambil secara restropektif dari 201 rekam medik (total sampling) pasien HIV baru di Klinik Teratai RSUP Dr. Hasan Sadikin periode Januari - Desember 2015. Hasil menunjukkan persentase stadium pasien HIV yaitu stadium 4(41,8%), 1(25,4%), 3(24,9%) dan 2(7,9%). Kebanyakan pasien terdiagnosis dan/atau berobat ketika sakitnya sudah parah atau justru saat screening pada kelompok berisiko. Jumlah pasien yang mengalami efek samping ARV lebih banyak (50,7%) dibanding yang tidak. Efek samping yang paling banyak muncul diantaranya mual, pusing, gatal dan ruam kemerahan pada kulit. Efek samping yang timbul bergantung pada variabilitas kadar ARV dalam plasma. Persentase pasien yang patuh menjalani terapi ARV adalah 58,2%. Tingkat kepatuhan sangat dipengaruhi oleh pengetahuan dan keyakinan akan pentingnya pengobatan. Disimpulkan bahwa efek samping yang timbul bervariasi dan dialami oleh lebih banyak pasien, jumlah pasien patuh menjalani terapi antiretroviral lebih dari setengah total jumlah pasien.Kata kunci: Antiretroviral, Efek samping, Kepatuhan, Pasien HIV, Stadium klinis.
Gut Microbiota in Human Immunodeficiency Virus Infection Wisaksana, Rudi; Darmawan, Guntur; Agustanti, Nenny; Girawan, Dolvy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 1 (2019): VOLUME 20, NUMBER 1, APRIL 2019
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Human microbiota, majority presents in human gastrointestinal tract, plays crucial role in body physiological functions, such as immune system. Human immunodeficiency virus (HIV) infection impairs gut barrier and alter the microbiota ecosystem, called dysbiosis. Several studies showed different composition of gut microbiota between healthy individual and HIV patient. Moreover, different phase of HIV infections had their own characteristic of gut microbiota. Antiretroviral treatment might improve the CD4 level, however, it inconsistently restore the gut ecosystem. Some studies in prebiotic and probiotic revealed the potential beneficial effect in gut microbiota. Probiotic might inhibit mucosal invasion, improve intestinal mechanical barrier integrity, reduce microbial translocation, restore mucosal immune function, counteract local inflammation and lower systemic inflammation.
Decreased Liver Fibrosis in Patients with Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) Coinfection After Treatment with Sofosbuvir/Daclatasvir Jonathan, Andreas; Wisaksana, Rudi; Agustanti, Nenny
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 2 (2019): VOLUME 20, NUMBER 2, AUGUST 2019
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (530.097 KB) | DOI: 10.24871/202201987-95

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Background: Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) co-infection increases the progression of liver fibrosis to advanced liver disease and death. The aim of this study is to determine whether the changes of liver fibrosis occur in HCV/HIV coinfection patients after therapy with Sofosbuvir/daclatasvir.Method: This study used a quasi-experimental study design without a control group. The study subjects were HCV / HIV coinfection patients who received Sofosbuvir / daclatasvir therapy in the Gastroentero-Hepatology Clinic of Dr. Hasan Sadikin Hospital. In this study measurement of liver fibrosis was carried out by using AST to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) before therapy and when SVR-24 was achieved.Results: The study involved 29 subjects. Most of the research subjects were men, with an average age of 40.38 years (SD 3.48). From the results of this study, we found a decrease in APRI scores and FIB-4 index when HCV / HIV coinfection patients, that were treated with Sofosbuvir / Daclatasvir, achieved SVR 24. The median of APRI scores before therapy and after SVR-24 was decreased from 0.41 to 0.28 (95% CI: 0.01 - 0.23, p-value 0,01) and the median of FIB-4 Index before therapy and after the SVR 24 was decreased from 0.94 to 0.81 (95% CI: -0, 04 - 0.35, p-value 0.28).Conclusion: This study concluded that therapy using Sofosbuvir / Daclatasvir in HCV / HIV coinfected patients has very good effectiveness and can reduce liver fibrosis.
Detection of Epstein-Barr Virus in Saliva and Gen LMP1 among HIVInfected Patients Munthe, Eliza Kristina M; Wisaksana, Rudi; Amalia, Riezki; Sufiawati, Irna
Journal of Dentistry Indonesia
Publisher : UI Scholars Hub

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Epstein-Barr virus (EBV) is also called human herpes virus 4 (HHV-4), has detected 95% of the population and shows an asymptomatic state. EBV is etiological agent of oral hairy leukoplakia (OHL) in HIV patients. Latent membrane protein 1 (LMP1), an integral EBV protein can modulate growth, differentiation, induce the expression of several cells, activation of antigens, and adhesion molecules. The LMP1 gene has been associated with OHL. Objectives: to determine the prevalence of EBV in saliva and the LMP1 gene in HIV/AIDS patients with EBV positive. Methods: A cross-sectional was conducted on HIV/AIDS patients. The presence of EBV in saliva was done by mciroarray PCR. LMP1 is examined by using nested PCR. Results: The research subjects involved 30 HIV/AIDS patients consisting 70% men and 30% women, with 50 % age group of 31-40 years old and 40% had CD4 counts <200 cells/mm3 (40%). EBV in saliva was found in 26 out of 30 (87%) HIV patients and LMP1 was detected in 17 patients (65.38%). Conclusion: The high prevalence of EBV in saliva and the LMP1 gene may increase the risk of OHL. Early screening for EBV infection in patients with HIV/AIDS is important to reduce the risk of EBV-associated diseases.