Profil Working Group on AIDS

Working Group on AIDS (Pokdisus AIDS FKUI/RSCM) is an institution organized by the Faculty of Medicine, University of Indonesia and Cipto Mangunkusumo General Hospital. The group was established since the first case of HIV was identified in Indonesia in 1986 by dr. Zubairi Djoerban. As a non-profit institution, Pokdisus AIDS is self-sufficient in running its activities and programs.

Appropriate health care services for People Living With HIV/AIDS (PLWHA) is the most crucial issue in Indonesia. However, lack of information about HIV/AIDS-related issue has made public, health professionals, and health providers unable and not ready to deal with HIV/AIDS cases.

Such circumstance has brought ample consequences such as increasing chances for PLWHA to get opportunistic infections, health expenses, and mortality rate among PLWHA so that family’s welfare becomes undermined.

To face such challenges, Pokdisus AIDS carries out complementary daily activities that are related with HIV/AIDS control. The activities encompass health education and training, hotline services, counseling and HIV testing, access to diagnosis and treatment, and also hospital referral.

Pokdisus AIDS and its self-reliant efforts have helped almost 2,000 PLWHA across the country have an access to generic-version of life-saving ARV since 1999. The group aims at helping and saving thousands others through accessible, sustainable, and affordable ARV drugs.

Access to Diagnosis and Therapy

Is there any medicine for AIDS in Indonesia? The desire to initiate AIDS therapy in Indonesia has grown stronger among members of Pokdisus. Pokdisus then established a team on Access to Diagnosis and Therapy in 1997, aiming at improving access to diagnosis (anti HIV test) and ARV therapy. Dr. Samsuridjal Djauzi is appointed as the coordinator of the team ever since.

In making the diagnosis on HIV/AIDS someone needed to be tested. However, voluntary counseling and testing (VCT) precedes HIV test. The team tried to prepare more extensive services by establishing cooperation with other hospitals besides RSCM and facilitating some training on counseling.

The CD4 lymphocyte test is the basic to develop AIDS therapy in Indonesia. Starting from 1998, HIV/AIDS management in RSCM has been equipped with CD4 lymphocyte and viral load test. The preparation of providng ARV therapy then continued to develop.

Pokdisus AIDS has imported patented ARV drugs since 1997 through license of special access issued by Indonesian Drugs and Food Control Agency (BPOM). A program manager of Pokdisus AIDS then visited India in the middle of  2001 and met local generic drugs preducers.

BPOM renewed its special license to Pokdisus to provide ARV drugs through special access that had been given to Pokdisus, so that Indian manufactured generic ARVs can be widely used in Indonesia since November 2001.

Pokdisus AIDS then established another collaboration with Thailand generic ARV producers in February 2002, enhancing access to AIDS therapy in Indonesia. In late 2002, Pokdisus AIDS approached state-run pharmaceutical firms PT Indofarma and PT Kimia Farma to improve access to generic ARVs. PT Indofarma then imported generic ARVs from India (2002) and Thailand’s Governmental Pharmaceutical oranization (2003).

Kimia Farma produced three types of generic ARVs in 2003 and plans to produce two other types in 2004. Besides ARVs, PLWHAs also often need opportunistic infection’s drugs, one of them is pirimetamin which is already manufactured by Kimia Farma in 2005.

Pokdisus has maintained some activities related to HIV/AIDS control. Those are classified as:

1.      Medical consultation (Monday to Friday/9 a.m  12 p.m)

2.      HIV personal counselling (Monday to Friday/9 a.m  3 p.m)

3.      VCT (voluntary, Counselling, and Testing) (Monday to Friday/9 a.m  12 p.m)

4.      HIV hotline consultation (Monday to Friday/9 a.m  3 p.m)

5.      Center of access to generic and patented ARV drugs

6.      Build Partnership through:

a.       Monthly Meeting among PLWHA, Family, Health Professionals, NGO activists & journalists (4th week of the month)

b.      Clinical Conference among health professionals & providers  (2nd and 4th week of the month)

c.       Case conference of counselors & buddies (1st week of the month)

7.      Health education program to community: religious and community leaders, schools, medical associations, academicians, etc.

8.      Developing training:

a)      Training on HIV/AIDS Counseling (materials: Introduction to Counseling; Effective Communication; Values and Cultural Background; Assessment of Risk Behavior, etc).

b)      Training on Managing HIV/AIDS Cases (materials: Universal Precaution; AIDS Epidemiology; HIV Test; HIV/AIDS Diagnosis; Managing IDU Patient; ARV Treatment)

c)      Internship on Managing HIV/AIDS Cases at Outpatient Unit; Inpatient Unit; Pharmacy; Clinical Pathology Unit; Networking with Puskesmas & Clinics

d)      Training on Empowering & Giving Support for PLWHA (Medical, Psychological, and Social Aspects of HIV Infection; Care, Support and Treatment; Adherence of ARV Intake; Advocacy to Family and Community; Cooperation with Health Care Providers)

9.      Developing networking

As of March 2006, the training has been conducted to more than 30 Districts/ Municipalities in Java, Sumatra, and Kalimantan. It will be held in some parts of Sulawesi and other Eastern regions in Indonesia. There are already more than 1,000 health professionals have been trained, so far.

10. Build supporting system:

§ publication information: brochures/leaflets, hotline service, website and e-mail address, baseline data (institutional address, contact number), etc.

§ easier access to get Post Exposure Prophylaxis  (PEP) drugs

§ Office hours:  7 days a week, from 9 a.m. through 3 p.m.

§ Regular educational program: seminar, workshop, etc.

Providing evidence based management for PLWHAs based on own experience in resource constraint country like in Indonesia is one of Pokdisus goal. Therefore, Pokdisus members as part of research university feel that there is always growing need to do scientific research even with a small budget and without the help of other funding.

Early Research

First research is Pokdisus was done in 1995 by dr. Samsuridjal Djauzi and dr. July Kumalawati. They conducted HIV testing through urine among 600 people as subject of this research.1 Meanwhile, dr. Lukas Mangindaan and his colleague, dr. Nurmiati Amir, conducted research on the impact of health education on behavioral changes.2 However, those researches have not been published so that the public is not exposed to the research results.

Clinical Research

The first published research was a research on clinical description and pattern of opportunistic infectious diseases conducted by dr. Aida Lydia in 1996. This is the first publication of research on clinical manifestation of AIDS in Indonesia.3 The major clinical manifestations that dr. Aida Lydia investigated are prolonged fever (100%), cough (90.3%), weight loss (80.7%), mouth ulcer, sore throat (78.8%), and diarrhea (69.2%). Meanwhile, opportunistic infections often found by order were oropharyngeal candidiasis (80.8%), tuberculosis (40.1%), cytomegalovirus retinitis (28.8%), toxoplasma encephalitis (17.3%), and Pneumonia p. carinii (PCP) (13.4%). Most of the diagnosis were based on presumptive diagnosis. She also found that CD4+ lymphocyte count was correlated with one third of total lymphocyte count in AIDS patients.

In 2002 dr. Maulana Suryamin found different pattern of opportunistic infection than previous report………… His research was done mostly among intravenous drug user while dr Aida research mostly among heterosexual transmitted patients. At that moment HIV cases were increased among drug user, especially opiate. Maulana also found that ARV therapy can be started when the total lymphocyte count was 1100, slightly different that the figure recommended by WHO (April 2002) that suggested that ARV can be used if total lymphocyte was below 1200.

Dr. Zubairi showed that there is no association between the number of CD4 and viral load in HIV/AIDS patients among drug users. The treatment of HIV/AIDS patients among drug users should be given according to the viral load.

Dr. Wigati made a research on the pattern of drug abused among patients in RSCM. She found out that HIV among IDUs in 2002 has reached 80%6 while dr. Samsuridjal Djauzi and dr. Rino A Gani found in 1999 the figure was only around 10%,7 and in 2001 dr. Nanang Sukmana found the figure was 40%.8 Among dr Wigati respondents, the usage of sharing needle was very high (76%).  Most of them report that one needle mostly used by more than 4 persons.

Along with the improvement of diagnostic capabilities for opportunistic infections, in 2005, dr. Evy Yunihastuti et al reported different pattern of opportunistic infections. The most prominent infection was tuberculosis (pulmonary TB 37.1%, extrapulmonary  TB 11.8%).9 More people are coming with cerebral infection. Widi Widowati et al reviewed the cause of meningitis in HIV infection. Over 80% was caused by toxoplasmosis.10  This is not surprising because the prevalence of positive toxoplasma serology Among HIV infected patients in Cipto Mangunkusumo hospitalwas 76%.11 Other causes of meningitis were tuberculosis and also Cryptococcus neoformans isolated from cerebrospinal fluid.

In dr. Evy Yunihastuti case series, she also found that the mean CD4 count at the time of HIV diagnosis is 187 cells/µL (range 1-1200). About 40% of them had CD4 count below 50 cells/ µL, indicating that they were coming in late stage of infection.

Dr. Ivo Novita Sah Bandar et al tried to correlate CD4 count and intensity of candida colonization in the oropharynx of HIV infected patients in 2005. She found that there was strong negative correlation (r = – 0.756) between CD4 count and the intensity of candida colonization. The most frequent (74.58%) species found in the oropharynx was Candida albicans. She also found C. krusei, C. parapsilosis, and C. tropicalis.

Parasitic infections from gastrointestinal tract and other sources also examined by the half of parasitologists. Dr. Teguh H. Karjadi and Dr. Agnes Kurniawan showed that Blastocytosis hominis could be one of the important cause of chronic diarrhea among HIV infected patients in Jakarta.13 We also found extraintestinal blastocytosis from ascitic fluid, lymph node, liver abscess aspirate, and sputum of AIDS patients and cultured in Jones’ medium.14 Other parasitic infections found were cryptosporidiosis, cyclosporiosis, giardiasis, strongiloidiosis, and ascariosis.

As a consequence of the increment of intravenous drugs users who practice sharing needles, we are also facing problem of hepatitis coinfection. In 2002, dr. Rino A. Gani reported the prevalence of hepatitis C among intravenous drug users was already 82%.15 In 2004, the prevalence of hepatitis C and HIV coinfection was 81% in Pokdisus AIDS clinic while the prevalence of hepatitis B was lower (11.8%).

Our clinical researches also involve dermatologists. Dermatological infections happened to PLWHA reported by dr. Prima were malasseziosis (pitriasis versicolor 7%, Malassezia foliculitis 13%, seborrhoic dermatitis 18%).17 Dr. Rahadi et al also studied that HIV infected patients had positive seroprevalence of Herpes Simplex Virus type-2 (26.09%) and Treponema pallidum (3.92%) in Pokdisus AIDS Cipto Mangunkusumo Hospital Jakarta.

Dr. Darma Imran tried to describe central nervous system opportunistic infection in AIDS as one of the main diagnostic challenges in PLWHA whichs is focal brain lesions (FBL). The most common process that produce FBL in patients with AIDS are toxoplasma encephalitis (TE), followed by primary CNS lymphoma (PCNSL), progressive multifocal leucoencephalopathy (PML), tuberculous infection and CMV.19 Besides opportunistic infection, dr. Darma Imran et al also reported prevalence of distal sensory polyneuropathy (DSP) in HIV infected patients affected by CD4 cell count. From 72 patients, 15 of them (20.8%) showed clinical and electroneurographic evidence of DSP. Apparently, there was significant association between lower CD4 count and DSP (p=0.002).

Not only physical aspect, we also concern about psychopathology aspect on PLWHAs. Psychopathology is widely recognized as a disturbing secondary effect of HIV/AIDS, causing further deterioration of patients’ quality of life. In 2004, Dr. Adhi Wibowo held the research against this aspect, aiming to get the frequency of psychopathology among PLWHA at Pelita Ilmu Clinic, Working Group on AIDS Clinic, and Dharmais National Cancer Center.21 Sixty three percent of PLWHA have a risk factor of IDUs, 25% of unsafe sex, while 12% of respondents have both of these risk factors. Frequency of psychopathology among PLWHAs were depressive episode and dysthymia (68%), drugs dependence (63%), generalized anxiety disorder (41%), alcohol dependence (17%), panic disorder (7%), single psychotic episodes (6%), social phobia (2%), recurrent psychotic episode (2%), and post traumatic stress disorder (1%). Dr. Elisa et al reported that psychopathology also happened among informal caregivers who accompanied AIDS-infected patients. Forty five percent of them were having depressive episode.

In general, cases managed at RSCM are already in advanced stage and dr. Nyoto Widyo A. found that the quality of life of PLWHA was very low. He observed physical, emotional, and social aspects of PLWHA’s quality of life.23 The average haemoglobine measurement of PLWHA was 10.8 g%. Almost 75% of PLWHA’s emotional condition was poor though they received pre and post counseling. Half of the PLWHA suffered from pain, only a quarter of them had no physical discomforts.

HIV/AIDS happens either in adult or children. Nutritional status and growth outcomes for children with HIV are still unpredictable. Dr. Suprohaita et al analyzed that from 60 pediatric patients with HIV/AIDS admitted to Cipto Mangunkusumo hospital in Jakarta during January 2003 to December 2004, 50% of them had growth failure problem with body weigh uner 3rd percentile on weight-age chart. Morbidity of the patients were diarrhea, tuberculosis, and bronchopneumonia.

HIV and women

HIV/AIDS has already transmitted to the family, either through sharing needles used by IDU or through unsafe sexual transmission. HIV/AIDS transmission risk to wives or husbands opens widely. According to data from Pokdisus AIDS, during January 2004 until July 2006, there were 309 women with HIV/AIDS and most of them (73.5%) were in childbearing age.25 Transmission risk through sexual is appointed about 70%, 11.33% had risk from intravenous drug users, while 11.65% had risk through both. This showed us that women are at high risk population. Some of women with HIV/AIDS has already join PMTCT program in Pokdisus.

Dr. Pringgodigdo et al tried to make pattern of opportunistic infection in women with HIV/AIDS.26 From 153 symptomatic cases in Pokdisus during January 2004 until July 2006, most of them has oropharyngeal candidiosis (49.7%) at early diagnose of HIV/AIDS, followed by pulmonary tuberculosis (29.4%), leucorrhea (15.7%), and chronic diarrhea (12.4%). The most interesting fact that those opportunistic infections except chronic diarrhea can be happened at any number of CD4 cell count.

Dr. Teti Ernawati et al showed interesting fact that there were 23.7% abnormal pap test in women with HIV/AIDS in Pokdisus AIDS. The most prominent case was low degree of neoplasia intraepithelial squamous (NIS) (11.3%).27 Most of the respondents had CD4 cell count less than 500 cells/mm3.

Anti Retroviral Era

Since 1996, antiretroviral (ARV) has been declared as one of the effective treatment in HIV patients. However, ARV also has many side effects as well as other medications. One of its side effects is nevirapine allergic as reported by dr. Evy Yunihastuti.28 Besides, she also reported that the incidence of drug allergy among HIV infected patients was 11.9%. The highest percentage of drug allergy was found in pyrimethamine-sulfadoxine use (34.2%).

Anemia commonly occurs during HIV infection due to HAART especially Zidovudine (AZT). Dr. Teguh H Karjadi showed in his research that AZT affected hemopoiesis and caused anemia in 51 of 372 patients taking regimen containing AZT (13.7%), thirteen of them need RBC transfusion.30 Risk factor related with AZT induced anemia were CD4 count (p=0.005) and baseline hemoglobine level (p < 0.001).

–       hepatotoxicity (Tanya dr. evy, Irsan).

Due to increment of HIV infection problem related to unsafe sex behavior and intravenous drug use, then since 2004 government has provided antiretroviral (ARV) for free. Voluntary counseling and HIV testing (VCT) is a must for a free access to ARV therapy. Based on dr. Vernawati’s research about usage of VCT in Primary Health Care (Puskesmas) Kampung Bali Jakarta, she found that numbers of VCT 8 months prior and 5 months after implementation of the policy were 18 ad 27 people.32 There was few increase in ARV usage. From 100 respondents who hadn’t done VCT, their reasons were feeling healthy, afraid of being recognized suffering from HIV, showing reluctance and less motivation. Out of 13 respondents who had done VCT, knew the risk, but 7 was still on routine injection and 10 had unsafe sex behavior. It is hoped that numbers of VCT will increase in line with the guarantee of ARV access. Lack of awareness, motivation and afraid of HIV/AIDS social consequences were the reasons that could hinder VCT.

ARV also can reduce morbidity and mortality. Dr. Amir Fauzan reported there was positive response to treatment (91.4%), complete response (70.5%), clinical response (1.4%), immunological response (20.1%), and no response to treatment (8.6%). Adverse reaction led by ARV were found 93.5%.

Still related to dr. Nyoto’s research previously mentioned, improvement of PLWHA’s quality of life associated with ARV.

Adherence to ARV therapy of 95% or greater seems to be required for the successful treatment of HIV/AIDS. Studies have shown that education is a cornerstone for establishing adherence. However, based on research held by Dinia N et al, there was no significant correlation between PLWHA’s level of knowledge about ARV therapy with their adherence to ARV therapy.34 This research empowered by K Widyasari et al in their report that there are no relationship between age status, education level, risk factor, drug amount consumed per day, period of therapy, with the adherence on consuming ARV drugs on PLWHA in Pokdisus Clinic Jakarta.

Still related to adherence to ARV, the research done by Intania W et al among IDU and non-IDU PLWHA at Dharmais Hospital Jakarta.36 She found 74% of the outpatients at that hospital have more than three Months experience using ARV drugs. 99 (91%) visiting clinic for consultation to the doctor and refill the drugs every month. 38 (34%0 of them very sure and 66 (60%) extremely sure that antiretroviral drugs will have a positive effect for their health status. However, there was no significant different between adherence among IDU and non-IDU in this study.

In 2002 HIV infected children started to appear. From January 2003 to October 2005, dr. Nia Kurniati reported that there were 80 children diagnosed to have HIV infection in Cipto Mangunkusumo Hospital.37 Only 64 patients received ARV treatment, and only 52 of them comply with ARV or OI prevention therapy. Clinical outcome was mostly use to define improvement, because immunological improvement was noted only in 13 patients, and virological improvement only in 8 patients.

Other studies

Pokdisus has also took an important part in some multicenter clinical studies, such as APNAC (The Asia Pacific NeuroAIDS Consortium) study in “A Study of the Prevalence of HIV-related Neurological Disease in the Asia Pacific Region” and Anti-retroviral Toxic Neuropathy (ATN) in collaboration with University of Western Australia and Monash University.

References:

§  Kumalawaty J, Djauzi S. Sensitivity and specificity of urine test for detection of HIV1 among 600 health care workers in Cipto Mangunkusumo hospital Jakarta. unpublished

§  Djauzi S, Nurmiati, Gunawan S. Effectivity of Counseling on risky behavior at Working Group on AIDS Cipto Mangunkusumo hospital Jakarta.unpublished

§  Lydia A. Total lymphocyte count as a predictor for CD4+ lymphocyte count among AIDS patient [thesis] Jakarta: Department of Internal Medicine School of Medicine University of Indonesia; 1996.

§  Suryamin M.  Total lymphocyte count as indicator to start antiretroviral therapy among people living with HIV/AIDS. [thesis] Jakarta: Department of Internal Medicine School of Medicine University of Indonesia; 2002

§  Wigati, Djauzi S, Sukmana N, Atmakusumah Dj. Correlation between the pattern of needle usage with the risk of injection and the decrease of cellular immunity to heroin injection. [Thesis] Jakarta: Department of Internal Medicine School of Medicine University of Indonesia; 2003.

§  Djauzi S, Gani RA. Hepatitis C and HIV among intravenous drug users in Cipto Mangunkusumo Hospital Jakarta. 1999. unpublished.

§  Sukmana N, Rohmi S. HIV prevalence among IDUs in a private hospital Jakarta. 2001. unpublished

§  Djoerban Z. Viral load profiles in drug users with asymptomatic HIV infection with normal CD4 cell counts. Med J Indones 2002; 11(3).

§  Wigati, Karjadi TH, Yunihastuti E, Imran D, Rohmi S, Kusbiantoro H, et al. Spectrum of opportunistic infections among HIV-infected patients in Jakarta. Abstract book Australasian Society of HIV Medicine Conference. Hobart, October 2005.

§  Imran D, Yunihastuti E, Jannis J, Tiksnadi A Misbach J. Empiric anti-toxoplasmic treatment in HIV-associated focal brain lesions. Profiles of HIV/AIDS in Neurology Department of Cipto Mangunkusumo Hospital, Jakarta. (Abstract from the 11th Asian Oceanic Congress of Neurology) J Clinical Neuroscience 2004;11: S15.

§  Pohan HT, Djauzi S, Khie Chen, Yunihastuti E, Sah Bandar IN. The seroprevalence of Toxoplasma gondii infection in HIV/AIDS patients. 2006 unpublished.

§  Imran D, Jannis J, Djoerban Z, Wibowo BS. HIV Distal Sensory Neuropathy. Neurona 2005;22(3):4-8.

§  Karjadi TH, Kurniawan A, Yunihastuti E, Djauzi S. GI parasitic infection in HIV infected persons in Jakarta intestinal parasitic infection in HIV/AIDS in Jakarta.Will be presented at Australasian Society of HIV Medicine Conference. Melbourne, 2006 October.

§  Kurniawan A, Karjadi TH, Yunihastuti E, Sulaiman AS. Extraintestinal blastocystosis in AIDS patients.

§  Sah Bandar IN, Widodo D, Djauzi S, Wahyuningsih R, Muthalib A. Correlation between CD4 count and intensity of Candida colonizations in the oropharynx of HIV-infected/AIDS patients. Indon J Intern Med 2006;

§  Esti PK, Boediardja SA, Budimulja U. Malasseziosis proportion in HIV infected adults in Pokdisus Clinic Cipto Mangunkusumo Hospital Jakarta. [Thesis]. Jakarta: Department of Dermatology and Venereology School of Medicine University of Indonesia, 2006.

§  Rahadi, Budimulja U, Wiryadi BE. Seroprevalence of Herpes Simplex Virus type-2 and Treponema pallidum in HIV infected patients in Pokdisus AIDS Cipto Mangunkusumo Hospital Jakarta. [thesis] Jakarta: Department of Dermatology and Venereology School of Medicine University of Indonesia, 2006.

§  Gani RA, Irsan H, Budihusodo U, Lesmana LA, Akbar N. HCV serology among intravenous drug users in Jakarta. Presented at PHTDI-PEGI Meeting. Medan, 2001.

§  Gani RA, Djauzi S, Yunihastuti E. Coinfection of HCV and HIV in Cipto Mangunkusumo Hospital, Jakarta. Preceeding of Asia Pasific Association for the Study of the Liver. Bali, 2005 July.

§  Karjadi TH. Hepatitis B coinfection among HIV infected patients in Cipto Mangunkusumo Hospital Jakarta. Presented at Institute of Human Virology and Cancer Biology Conference. Jakarta, 2004 August

§  Suprohaita, Tanzil RS, Sjarif DR. Growth failure among HIV-AIDS patients at Cipto Mangunkusumo Hospital Jakarta. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Wibowo A. Frequency of psychopathology among people living with HIV/AIDS (PLWHA) with injecting drug user and unsafe sex as a risk factors at three clinics in Jakarta.[thesis] Jakarta: Department of Psychiatry School of Medicine University of Indonesia, 2003

§  Tandiono E, Sasanto W, Danardi. Frequency of mental disorders experienced by informal caregivers of AIDS infected patients in Pokdisus AIDS Cipto Mangunkusumo Hospital Jakarta. [thesis] Jakarta: Department of Psychiatry School of Medicine University of Indonesia, 2006

§  Astoro NW, Djauzi S, Djoerban Z, Prodjosudjadi W. Quality of life PLWHA and its risk factors. [thesis] Jakarta: Department of Internal Medicine School of Medicine University of Indonesia; 2004

§  Bratanata J, Nugroho P, Matulessy TG, Tamlicha T, Yunihastuti E, Djauzi S. Profile of women with HIV/AIDS in Pokdisus AIDS Cipto Mangunkusumo Hospital Jakarta. Preceeding of Annual Scientific Meeting of Internal Medicine. Jakarta. 2006 August.

§  Nugroho P, Bratanata J, Matulessy TG, Tamlicha T, Yunihastuti E, Djauzi S. Clinical manifestation in women with HIV/AIDS and its correlation with CD4 cell count in Pokdisus AIDS Cipto Mangunkusumo Hospital Jakarta. Preceeding of Annual Scientific Meeting of Internal Medicine. Jakarta. 2006 August.

§  Ernawati T, Indarti J, Kusuma F, Djauzi S, Sukmana N. Pap test finding and number of CD4 cell count in women with HIV/AIDS in Pokdisus AIDS Cipto Mangukusumo Hospital Jakarta. 2006. [thesis] Jakarta: Department of Obstetric and Gynecology School of Medicine University of Indonesia; 2006.

§  Yunihastuti E, Sukmana N, Rachmadi K. Incidence of rash and discontinuation of nevirapine among ARV naïve patients in Cipto Mangunkusumo Hospital Jakarta. Abstract book Australasian Society of HIV Medicine Conference. Hobart, October 2005.

§  Yunihastuti E, Karjadi TH, Sukmana N, Imran D, Daili SF, Djauzi S. The incidence of drug allergy among HIV infected adults in Jakarta. Abstract and Program Book Jakarta Allergy and Clinical Immunology Meeting in conjuction with Asia Pacific of Pediatric Allergy and Clinical Immunology Association meeting. Jakarta, 2006 April.

§  Karjadi TH, Yunihastuti E, Sukmana N, Djoerban Z. Anemia in patients HIV with zidovudine therapy. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Yunihastuti E, Hasan I, Sukmana N. Transaminase alteration after initiation of nevirapine-containing regimen among HIV-infected patients. Presented at Institute of Human Virology and Cancer Biology Conference. Jakarta, 2004 August.

§  Fauzan A, Djauzi S, Djoerban Z, Sukmana N. Response to antiretroviral treatment in Cipto Mangunkusumo Hospital Jakarta. [Thesis]. Jakarta: Department of Internal Medicine School of MedicineUniversity of Indonesia; 2004

§  Mahdi HIS, Djauzi S, sukmana N, Oemardi M. One Year AIDS patient`s survival in Dharmais cancer hospital

§  ( Retrospective study analysis). [Thesis]. Jakarta: Departement of Internal Medicine School of Medicine University of Indonesia; 2004.

§  Dinia N, Puspita T, Yunihastuti E, Harianto. The correlation between PLWHA’s level of knowledge about antiretroviral therapy with PLWHA’s adherence to antiretroviral therapy in Pokdisus Clinic Jakarta. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Widyasari K, Puspita T, Yunihastuti E, Harianto. Factors affecting PLWHA adherence to use antiretroviral drugs in Pokdisus Clinic Jakarta. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Intania W, Kusmalasari L, Sani A, Andalusia R, Mahyudin M. Adherence to ARV among IDU and non IDU people living with HIV/AIDS (PLWHA) at outpatient clinic Dharmais Hospital Jakarta. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Kurniati N, Akib AAP. Antiretroviral in HIV infected children. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Wiyono LD, Basuri, Marini TM, Rivaida A. Correlation between plasma level of vitamin E, C, beta carotene, Zn, and selenium with CD4 cell count in HIV/AIDS patients. 2006. [thesis] Jakarta: Department of Clinical Nutrition Faculty of Medicine University of Indonesia. 2006.

§  Vernawati SA, Djauzi S, Djoerban Z, Widodo D, Rismawati. Usage of voluntary counseling and HIV testing (VCT) services in Puskesmas Kampung Bali Jakarta and its relation with the government policy regarding access of antiretroviral for all. [thesis]. Jakarta: Department of Internal Medicine School of Medicine University of Indonesia; 2004.

§  Prawitasari T, Kurniati N, Rukmini NKP, Dewinta M, Syarif DR. Characteristics of HIV infected children with severe malnutrition. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Lubis N, Marsal, Jannis J, Diatri NL. Cognitive impairment in AIDS-related CNS opportunistic infection.Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Yunihastuti E, Karjadi TH, Sukmana N. HIV occupational exposure reported to Pokdisus AIDS 2004-2006. Will be presented at Australasian Society of HIV Medicine Conference. Melbourne, 2006 October.

§  Khosama H, Lubis N, Faulina L, Imran D, Jannis J. Relation between CD4 cell count and brain CT scan finding in HIV positive patients.Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Tiksnadi A, Imran D, Syeban Z. Profiles of seizure in HIV-infected patients. Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Yunihastuti E, Humardhani A, Sukmana N,  Djauzi S. Total lymphocyte count is not a sensitive predictor of CD4 cell count among antiretroviral naïve patients in Jakarta.Abstract and Program Book of Indonesian Association of Physicians in AIDS Care (PDPAI) scientific meeting. Jakarta, 2005 Nov 26-28.

§  Khosama H, Lubis N, Widowati W, Imran D, Janis J, . Cerebral toxoplasmosis in Jakarta. Will be presented at Australasian Society of HIV Medicine Conference. Melbourne, 2006 October.

§  Lubis N, Imran D, Janis J. Cryptococcal meningitis in Jakarta. unpublished

§  Sumantri G, Djauzi S, Hakim M, Lumempo S. P300 in HIV patients with CD4 more than 200 cells/ml. unpublished

Abstracts of these studies can be ordered by email to pokdisus@centrin.net.id

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