Pengaruh Terapi Vitamin D Terhadap Kadar Kalsidiol dan CD4 pada Anak dengan Human Immunodeficiency Virus Dalam Terapi Antiretroviral

Reza Chandra Abdilla, Rustam Siregar, Fadhilah Tia Nur

Sari


Latar belakang. Publikasi ilmiah terdahulu telah membuktikan bagaimana vitamin D berdampak terhadap imunitas pasien HIV. Kadar vitamin D yang adekuat berkaitan erat dengan luaran klinis dan kadar CD4 yang lebih baik. Hingga kini belum terdapat penelitian yang mengkaji pengaruh terapi vitamin D pada anak HIV dalam terapi antiretroviral di Indonesia.
Tujuan. Untuk menganalisis pengaruh terapi vitamin D terhadap kadar kalsidiol dan CD4 pada pasien HIV dalam terapi antiretroviral.
Metode. Penelitian ini bersifat pra-eksperimental dengan pretest-posttest design. Kriteria inklusi subjek penelitian adalah pasien HIV dalam terapi antiretroviral lini pertama, berada dalam stadium klinis HIV satu atau dua, berusia kurang dari 18 tahun. Penelitian dilaksanakan di Rumah Sakit dr. Moewardi, Surakarta pada periode waktu Maret – September 2020. Kadar kalsidiol dan CD4 diperiksa sebelum dan sesudah intervensi pemberian vitamin D. Pasien dengan kadar insufisiensi atau defisiensi vitamin D diberikan vitamin D3 2000 IU/hari selama 24 minggu. Uji analisis multivariat dilakukan dengan t-test berpasangan, dimana nilai p<0,05 dianggap signifikan.
Hasil. Didapatkan peningkatan yang signifikan pada kadar kalsidiol pasien sebelum dan sesudah intervensi yaitu 18,29ng/ml +5,37dan 32,34ng/ml + 6,78, juga didapatkan peningkatan kadar CD4 dari 860.74/mm3 +396,09 dan 1020.26/mm3 +520,63 secara berurutan.
Kesimpulan. Terdapat peningkatan yang signifikan terhadap kadar kalsidiol dan CD4 pada pasien HIV dalam terapi antiretroviral setelah terapi vitamin D.


Kata Kunci


Antiretroviral; CD4; HIV; kalsidiol; vitamin D

Teks Lengkap:

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Referensi


Rivera DM, Frye RE. Pediatric HIV Infection. 2018. [diakses tanggal 3 Februari 2019]. Didapat dari : https://emedicine.medscape.com/article/965086-overview.

Brooks M. Study supports earlier initiation of HAART in HIV infected children. Medscape Medical News. 2014.

Yin DE, Warshaw MG, Miller WC, dkk. Using CD4 percentage and age to optimize pediatric antiretroviral therapy initiation pediatrics. 2014;134:1104-16.

Welz T, Childs K, Ibrahim F, dkk. Efavirenz is associated with severe vitamin D deficiency and increased alkaline phosphatase. AIDS. 2010;24:1923–8.

Mueller NJ, Fux CA, Ledergerber B, dkk. High prevalence of severe vitamin D deficiency in combined antiretroviral therapy naive and successfully treated Swiss HIV patients. AIDS. 2010;24:1127–34.

Childs K, Welz T, Samarawickrama A, Frank A. Post. Effects of vitamin D deficiency and combination antiretroviral therapy on bone in HIV-positive patients. AIDS 2012;26:253–62.

Viard JP, Souberbielle JC, Kirk O, dkk. Vitamin D and clinical disease progression in HIV infection: results from the EuroSIDA study. AIDS 2011;25:1305–15.

Lee JY, So TY, Thackray J. A review on vitamin D deficiency treatment in pediatric patients. A review on vitamin D Deficiency Treatment in Pediatric Patients 2013;18:277–91.

Sastroasmoro S, Ismael S. Dasar-dasar metodologi penelitian klinis. Uji Klinis. Jakarta: Sagung Seto; 2014.h.196.

Kakalia S, Sochett EB, Stephens D, Assor E, Read SE, Bitnun A. Vitamin D supplementation and CD4 count in children infected with human immunodeficiency virus. J Pediatr 2011;159:951-7.

Stallings VA, Schall JI, Hediger ML, dkk. High-dose vitamin D3 supplementation in children and young adults with HIV: A randomized, placebo-controlled trial. Pediatr Infect Dis J 2015;34:32-40.

Zhou C, Assem M, Tay JC, dkk. Steroid and xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug-induced osteomalacia. J Clin Invest 2006;116:1703-12.

Brown TT, McComsey GA. Association between initiation of antiretroviral therapy with efavirenz and decreases in 25-hydroxyvitamin D. Antivir Ther 2010;15:425–9.

Misra M, Pacaud D, Petryk A, Paulo Solberg FC, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398-417.

Yonemura K, Fujimoto T, Fujigaki Y, Hishida A. Vitamin D deficiency is implicated in reduced serum albumin concentrations in patients with end-stage renal disease. Am J Kidney Dis 2000;36:337-44.

Bikle DD, Siiteri PK, Ryzen E, Haddad JG. Serum protein binding of 1,25-dihydroxyvitamin D : A reevaluation by direct measurement of free metabolite levels. J Clin Endocrinol Metab 1985;61:969-75.

Coelho L, Cardoso SW, Luz PM, Hoffman RM, Mendonça L, Veloso VG. Vitamin D3 supplementation in HIV infection: effectiveness and associations with antiretroviral therapy. Nutr J 2015;14:81.

Loser K, Beissert S. Regulation of cutaneous immunity by the environment: an important role for UV irradiation and vitamin D. Int Immunopharmacol 2009;9:587–9.

Rosa MD, Malaguarnera M, Nicoletti F, Malaguarnera L. Vitamin D3: a helpful immuno-modulator. Immunology 2011;134:123–39.

Duvic M, Ulmer R, Crane M, Goller M, Aduppong A, Lewis DE. Treatment of HIV patients with UVB is as-sociated with a significant increase in p24 antigen levels. J Invest Dermatol 1995;104:581A.

Fotiades J, Soter NA, Sanchez MR, Moy AJ. A three year follow-up evaluation on 28 HIV-positive patients treated with ultraviolet B (UVB) phototherapy. J Invest Dermatol 1995:104: 660A.

Akaraphanth R, Lim HW. HIV, UV and immunosuppression. Photodermatol Photoimmunol Photomed 1999;15:28–31.




DOI: http://dx.doi.org/10.14238/sp23.3.2021.143-9

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