CHAPTER I

BACKGROUND

Human immunodeficiency virus (HIV) is a pathogen that invades human immune system,
especially all cells that have CD4+ marker in their surface like macrophages and T lymphocytes,
while Acquired Immunodeficiency Syndrome (AIDS) is a immunosuppressive condition
(syndrome) that closely related to various opportunistic infections, secondary neoplasm, as well
as specific neurologic manifestation do to HIV infection.1 According to Ditjen PP & PL
Kemenkes RI 2014, total cumulative of HIV cases was reported as 150.285 cases and AIDS was
reported as 55.799 cases. In West Kalimantan, it was reported as 1.669 cases.2 Whereas for the
number of new cases in West Kalimantan according to Indonesian Helath Profile 2014, it was
reported as 699 cases, which was the highest tenth from all provinces in Indonesia.3 In 2011,
Dinas Kota Pontianak reported the number of HIV and AIDS cases which came from Voluntary
Counseling Test (VCT) in Pontianak which was 320 cases that consisted of 206 HIV cases and
114 AIDS cases. Of the total cases of HIV-AIDS during 2011, there were 23 patients who have
died.4

Generally, hepatitis is a liver infection disease due to hepatitis A, B, C, D, and E virus.

The similarity of hepatitis virus characteristic causes such virus easy to enter simultaneously and
causes co-infection.5 HIV-positive patients often develop Hepatitis co-infection because sharing
the same transmission route such as concurrent use of needle, sexual intercourse, and
transmission from mother to her baby.6 HIV infection not only increase the possibility of chronic
Hepatitis infection, but also accelerate the development of its complications such as cirrhosis and
hepatocellular malignancy as well as increase viremia level of Hepatitis virus in blood, whereas
the degree of impact of Hepatitis infection on HIV disease development is difficult to measure
due to multiple factors that can affect the findings of the study such as ART (Anti Retroviral)
administration.7

Hepatitis B virus infection in liver can be acute or chronic. HBV (Hepatitis B virus)
infection contribute to increased morbidity and mortality continuously in patients with HIV
infection. According to WHO 2014 data, more than 240 million population of the world develop
chronic HBV infection, and more than 780.000 people died annually due to acute or chronic
HBV complication. Indonesia itself is endemic country of HBV with HbsAg seroprevalence of
94% (range 2,5-36,1%) and carrier of 5-10% of general population. A total of 70% of HIV
infected patients has proven to develop acute or chronic hepatitis B infection. Mechanism
underlying the higher risk of HBV infection is related to the similar mode of transmission
through sexual and parenteral.5,8 While the hepatitis C virus is the RNA virus that cause hepatitis
C which is classified into flavivirus. This virus also enter into the blood through blood
transfusions or activities that allow the virus directly exposed to blood circulation. HCV main
target is the liver cells and it replicates very quickly that exceed HIV and HBV (hepatitis B
virus).9

Riskesdas 2013 report stated that the prevalence of hepatitis in all ages in 2013 was
1,2%, two times higher than in 2007 with the proportion of hepatitis B patients in West
Kalimantan of 30,7% which was much higher than the proportion of hepatitis C which only
3,1%.10 A study by Sepsatya in Rumah Sakit Umum Pemerintah (RSUP) dr. Kariadi Semarang
from 2009-2010 of 132 HIV patients, it was known that the incidence of HIV-hepatitis co-
infection was 36 (27,3%) with the rate of hepatitis B co-infection was higher than hepatitis C co-
infection and mixed hepatitis B and C of 26 patients (19,7%), while the incidence of HIV-HCV
co-infection consecutively was 3 patients (2,27%) and 7 patients (5,30%), respectively.11
 CHAPTER II
PROBLEM FORMULATION

According to WHO 2014, more than 240 million of world population developed chronic
hepatitis infection and more than 780 thousand people died every year because of the
complications. Liver disease-related mortality is eight times more likely in those with HIV-HBV
co-infection compared with those who only infected with HIV and nearly 19 times more likely
compared with those who only infected with HIV. While co-infection of Hepatitis C and HIV
will worsen the prognosis and cause death. According to regulation of health minister of the
Indonesia no. 87 2014 about antiretroviral therapy guidance if possible, HbsAg test should be
done to identify people with HIV and hepatitis B co-infection and HIV patients who need
Antiretroviral (ARV) initiation with Tenofovir Disoproxil Fumarate (TDF)` whereas for anti-
HCV examination, it has not routinely done in Indonesia for every HIV patients. There is
currently no complete data of co-infection HBV and HCV with HIV prevalence in HIV/AIDS
patients in Melati Clinic RSUD dr. Soedarso Pontianak. Response to therapy in patients who are
early diagnosed will provide therapeutic success around 80% rather than co-infected patients
treated at time of chronic hepatitis which is around 44%.

The problem formulation taken was how was the prevalence of HBV and HIV co-
infection in HIV/AIDS patients in Melati clinic of RSUD dr. Soedarso?