Diagnosis dan Penanganan TB-IRIS Paradoksikal
Tinjauan Pustaka
DOI:
https://doi.org/10.55175/cdk.v52i10.1544Kata Kunci:
HIV, IRIS, TB-IRIS, tuberkulosisAbstrak
Tuberkulosis (TB) merupakan infeksi oportunistik yang sering terjadi pada pasien human immunodeficiency virus (HIV). TB-HIV masih menjadi beban kesehatan di seluruh dunia terutama di negara endemis TB seperti di Indonesia, sehingga meningkatkan mortalitas. Pasien HIV perlu diberi obat anti-retroviral (ARV) sedini mungkin, namun jika ada komorbid dengan TB sering terjadi reaksi sindrom pulih imun (immune reconstitution inflammatory syndrome/IRIS), sehingga dapat memperburuk klinis pasien dan meningkatkan mortalitas. TB-IRIS terbagi menjadi 2 kategori, yaitu TB-IRIS paradoksikal pada pasien yang telah mendapatkan terapi TB sebelumnya dan unmasking TB-IRIS pada pasien yang baru terdiagnosis TB setelah inisiasi ARV. Manifestasi klinis TB-IRIS meliputi perburukan gejala respirasi, konstitusional, serta munculnya lesi baru pada organ lain. Diagnosis TB-IRIS menuntut eksklusi terhadap kondisi lain seperti infeksi oportunistik atau kegagalan terapi TB. Strategi pencegahan meliputi skrining TB sebelum inisiasi ARV, pemilihan waktu pemberian ARV yang tepat, serta penggunaan corticosteroid seperti prednisone untuk menurunkan risiko perburukan. Penanganan TB-IRIS difokuskan pada terapi suportif, kontrol inflamasi, serta kelanjutan pengobatan ARV dan OAT. Dengan deteksi dini, pencegahan, dan tata laksana yang tepat, angka morbiditas dan mortalitas akibat TB-IRIS dapat ditekan secara signifikan.
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Referensi
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