Kegagalan Terapi Infeksi HIV/AIDS dan Resistensi Antiretroviral

Rachmat Sumantri

Abstract


Kegagalan pengobatan infeksi human immunodeficiency virus (HIV) ditandai dengan kegagalan virologis, kegagalan imunologis, dan memburuknya keadaan klinis penderita. Kegagalan virologis mendahului kegagalan lainnya dan ditandai dengan viral load yang tidak menurun setelah 48 minggu pengobatan antiretroviral (ARV). Kegagalan imunologis ditandai dengan CD4 yang menurun. Faktor yang berperan dalam kegagalan terapi ARV adalah kepatuhan, efek samping obat yang menyebabkan penghentian obat, absorbsi buruk, dosis suboptimal, serta resistensi virus. Virus HIV akan bermutasi dengan jenis mutasi yang khas untuk setiap jenis obat ARV. Pemeriksaan resistensi ARV terdiri dari dua cara, genotip dan fenotip. Pemeriksaan genotip adalah pemeriksaan terhadap mutasi, sedangkan pemeriksaan fenotip adalah pemeriksaan in vitro untuk melihat langsung suseptibilitas ARV. Mutasi virus untuk tiap obat berbeda, ditandai dengan penggantian asam amino pada suatu kodon. Misalnya untuk lamivudin bila terdapat mutasi M184V, artinya metionin pada kodon 184 diganti dengan valin. Pemeriksaan mutasi virus perlu dilakukan jika diduga terjadi virologic failure akibat resistensi ARV, obat ARV yang diberikan harus segera diganti.

 

TREATMENT FAILURE IN HIV INFECTION/AIDS AND ANTI RETROVIRAL RESISTANCE

Treatment failure in HIV patient is usually marked by virological failure, immunological failure, and clinical deterioration of the patient. Virological failure preceded other failures and characterized by no decrease in viral load after 48 weeks of antiretroviral treatment. Immunological failure is characterized by  CD4 decreased. Factors contributed to the failure of ARV treatment are adherence to treatment, side effects of drugs that cause drug withdrawal, poor absorption, suboptimal dosage, as well as virus resistance. It is known that virus mutation is typical for every type of antiretroviral. HIV will mutate according to the type of mutation which is typical for each type of ARV drugs. ARV resistance examination consists of two methods, genotype and phenotype. Genotype detection is the examination to detect mutation, whereas phenotype detection is the direct examination of in vitro susceptibility to anti retroviral drugs. Mutation of the virus from each drug is different, characterized by amino acid replacement at a codon. For example, when lamivudine M184V mutation is found, methionine at codon 184 is replaced by valine. Examination of viral mutation should be done if virological  failure is suspected to cause ARV resistance and the suspected drug should immediately be replaced.


Keywords


ARV; HIV/AIDS; kegagalan pengobatan; mutasi; mutation; treatment failure



DOI: https://doi.org/10.29313/gmhc.v1i1.1513


pISSN 2301-9123 | eISSN 2460-5441

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