Mycobacterium

tuberculosis
infection in a
HIV-positive
patient
Maria Theresa
Montales
Alexandria Beebe
Arun Chaudhury
Naveen Patil
 Abstrak

Mycobacterium Tuberculosis dan

Human Immunodeficiency Virus ko-
infeksi merupakan tantangan global
yang harus ditanggulangi
Pada Jurnal Ini akan melaporkan Pria
Afrika-amerika umur 40 tahun
dengan HIV(+), tidak ada efek
samping ARV, dan memiliki TB
 Abstrak

Pria mengeluh batuk lama, keringat pada malam

hari dan penurunan berat badan yang tidak
diketahui
Positif T-SPOT-TB
Tapi pemeriksaan radiografi dada dan Sputum
normal
PCR-based GENE XPERT MTB/RIF terkonfirmasi MTB
Kultur MTB dapat diobati dengan seluruh ant-TB
medikasi.
Diperlukan Diagnosis dan inisiasi terapi yang cepat
 Pendahuluan

Microbacterium Tuberculosa dan Human Immunodeficiency

Virus Ko-Infeksi merupakan salah satu masalah global.
Menurut WHO, 15% terdiagnosis MTB-HIV dan meninggal
360.000
MTB merupakan Infeksi opportunistik akibat Viral load
menigkat dan Penurunan jumlah CD4, dapat menyebabkan
kematian pada pasien AIDS
HIV meningkatkan resiko Progresi MTB dan reaktivasi latent
TB Infection
HIV dapat menyulitkan klinisi karena hasil klinis TB menjadi
tak terlihat
Immune Reconstution Inflammatory Sindrome (IRIS)
merupakan efek dari obat MTB dan HIV
 CASE REPORT

Nama : Tn. X
Umur : 41 tahun
HIV
Riwayat pernah masuk Penjara
karena urusan pekerjaan
Pasien mengeluh Demam, keringat
malam hari, berdahak, dan kenaikan
berat badan yang diingat pasien
 CASE REPORT

Diagnosis HIV tahun 2005, tidak ada

keluhan terhadap ARV dan tidak
dalam pengobatan penyakit lain
Hasil Laborat Pasien :
Leukosit : 3,73 x 103 / mm3
Liver function normal
CD4 = 130 / mm3
Viral load > 500.000 copies / ml
 CASE REPORT

Hasil X ray Normal

T-SPOT TB (+) 1 tahun yang lalu
Sputum (-)
PCR dengan GeneXPERT MTB/RIF
mendeteksi M. Tuberculosis tanpa
resistensi rifampisin
 CASE REPORT

Pasien diberikan pengobatan awal :

Isoniazid
Rifampisin
Etambutol
Pirazinamid
 Discussion

Pasien ini merupakan pasien dengan

HIV(+). Terdapat gejala klinis TB
namun tidak ditemukan pada foto
thoraks dan sputum.
Hal ini sesuai dengan studi yang
mengatakan bahwa presentasi
radiologi tidak begitu khas pada
pasien TB dengan HIV
 Discussion

Perlu meningkatkan kewaspadaan

pasien TB dengan HIV yang
menampakkan gejala klinis seperti
Pneumonia
Sering terlambat Pengobatan anti TB
menyebabkan Perkembangan dan
pertumbuhan cepat bakteri M.
Tuberculosa dan Tingginya Angka
mortalitas
 Nucleic Acid Amplfication
based tests -WRD
Cartridge based NAAT Automated Real-time PCR platform
Xpert MTB/RIF should thus be made widely available as the initial
diagnostic test in HIV clinics and HIV prevalent* settings
It is a rapid, simple and highly sensitive TB diagnostic tool that can
easily be deployed close to the point of patient care.

*HIV-prevalent settings: where the adult HIV prevalence rate among pregnant
women is 1% or HIV prevalence among tuberculosis patients is 5%.
 SUMMARY OF WHO
RECOMMENDATIONS ON
XPERT MTB/RIF FOR PLHIV
1. Xpert MTB/RIF should be used rather than conventional microscopy,
culture and DST as the initial diagnostic test in adults and children
suspected of having HIV-associated TB or of having MDR-TB (strong
recommendation).

2. Xpert MTB/RIF should be used in preference to conventional microscopy

and culture as the initial diagnostic test for CSF specimens from patients
suspected of having TB meningitis (strong recommendation).

3. Xpert MTB/RIF may be used as a replacement test for usual practice

(including conventional microscopy, culture or histopathology) for testing
specific non-respiratory specimens (lymph nodes and other tissues) from
patients suspected of having extrapulmonary TB (conditional
recommendation).
THE ROLE OF XPERT MTB/RIF IN
THE CASCADE OF CARE FOR
PLHIV

PLHIV should be screened for TB symptoms at each visit to a health

facility or each encounter with a health care worker.
Adults and adolescents living with HIV look for any one of the
following symptoms: current cough, fever, weight loss or night sweats

Children living with HIV look for any one of the following : poor
weight gain, fever, current cough or contact history with a TB case

If the evaluation shows any of the above, PLHIV should be tested for
active TB, preferably by Xpert MTB/RIF
EVIDENCE ON USE OF XPERT MTB/RIF
FOR DETECTING TB IN PEOPLE LIVING
WITH HIV

Xpert MTB/RIF is sensitive and specific for the detection of PTB when
used as the initial diagnostic test in adults presumed to have HIV-
associated TB.
It detects 79% of the pulmonary TB cases among PLHIV, which is far
superior to smear microscopy.
Increases case detection of TB by around 45% compared with microscopy
among PLHIV enrolling in ART in South Africa.
Improves the quality of rapid TB diagnosis among PLHIV by providing
bacteriologically confirmed diagnosis in 36 75% of pulmonary TB patients
who are smear-negative.
Facilitates earlier diagnosis and reduces time-to initiation of TB
treatment, especially for smear negative pulmonary TB and at
decentralized clinics in areas of high HIV prevalence
 Xpert MTB/RIF

Xpert MTB/RIF improves sensitivity, timeliness of detection of

rifampicin resistance in adults and children living with HIV.
Use of Xpert MTB/RIF to detect TB among PLHIV thus facilitates timely drug
susceptibility testing (DST) for detection of MDRTB or XDR-TB and treatment
initiation with the correct drug regimen

However, like any diagnostic tool, Xpert-MTB/RIF may be unable to

impact TB morbidity and mortality, unless the test is embedded into
a supportive and efficient health care system
 Discussion

Perlu kewaspadaan terhadap

pengobatan TB dengan HIV
Perlu berhati-hati terhadap Toksisitas
obat, potensial drug interactions, dan
komplikasi seperti IRIS dan TB-MDR
Apabila CD4<200 , ARV baru dimulai
2-8 minggu setelah pengobatan TB
dimulai
 Kesimpulan

Diperlukan penegakan diagnosis TB

yang lebih dari standart
Berhati-hati terhadap Efek samping
obat, potensial drug interactions dan
efek toksik
Perlu mewaspadai timbul komplikasi
berupa IRIS
Terima Kasih