Challenges in diagnosing and managing TB-HIV co-infection in Yogyakarta, Indonesia.

Stoepker, L. (Leon) (2013) Challenges in diagnosing and managing TB-HIV co-infection in Yogyakarta, Indonesia. thesis, Medicine.

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Abstract

Tuberculosis (TB) is a huge global health problem, with increasing problems due to the emergence of human immunodeficiency virus (HIV) co-infection and multidrug-resistant (MDR)-TB. Indonesia carries the third highest TB burden globally. Co-infection of HIV and TB has been increasingly recognized. HIV attacks CD4+ T-lymphocytes, thereby compromising defense against intra-cellular organisms such as M. tuberculosis. In the presence of HIV, TB is associated with substantially higher case fatality rates. This can be explained by many challenges in diagnosing and managing TB-HIV. When TB patients are co-infected with HIV, the clinical presentation of TB is less characteristic than in TB patients without HIV co-infection. Besides the often absent characteristic symptoms, the lab results are mostly none-conclusive as well. In treating both diseases, various problems in compliance occur, making patients more prone to default. The study is a retrospective cohort and observational study of TB patients who received treatment in Sardjito General Hospital from 2009-2012. The fact that diagnosing TB in HIV co-infected patients is difficult can be supported by our findings. Sputum smear microscopy was negative in almost all patients. There are no other available tools to confirm diagnosis TB currently. Development of a new tool that would help in diagnosing TB would be a great improvement. In treating patients, our data displays a high number of defaulting patients. In the context of HIV, this may result in early relapse of disseminated TB and death. For future perspectives this study shows that improvements can be made in administration of patients and their care. Management in both TB as HIV should be strict and communication within a medical clinic, between both disciplines, concerning TB and HIV is essential.

Item Type:	Thesis (Thesis)
Supervisor name:	Werf, prof. T.S. van der
Supervisor name:	Subronto, dr. Yanri Wijayanti and Dr. Sardjito Hospital, Yogyakarta
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2642

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