TB HIV PRIA

7/23/2019 TB HIV PRIA

1/74

DAFTAR HALAMAN

DAFTAR HALAMAN...................................................................................................................1

IDENTITAS PASIEN......................................................................................................................2

ANAMNESIS..................................................................................................................................2

PERTANYAAN KASUS...............................................................................................................21

TINJAUAN PUSTAKA................................................................................................................28

1. TUBERKULOSIS (TBC)..........................................................................................................28

2. HIV/ AIDS.................................................................................................................................38

3. TUBERKULOSIS HIV (TB-HIV)............................................................................................

. PERIPARTUM CARDIOMIOPATI..........................................................................................!

!. KANDIDIASIS ORAL.............................................................................................................."#

". DIARE KRONIK .................................................................................................................... "1

$. HUBUN%AN KEBUTUHAN %I&I DEN%AN TUBERKULOSIS ....................................... "

KESIMPULAN..............................................................................................................................$

DAFTAR PUSTAKA.....................................................................................................................$!

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I. Identitas Pasien

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- P','@','5

65,6+, 5>

65+@'6

P9

P

-I A5,67

A6+69 2#7/

- D67+6 11 PO

- >5,6'+ 12'@

- %5'6>6 11"#

7

- PCT 6 3!##

- S@6,++'>+12! 7

- N6'6 9,+@

31>>

-R'6696 21 '@

- C,>' 31

- RH&E

3!#/3##/$!#/$!#

- M6+696 21

- M5>+;''6 6:

21'@

19


20/74

1/11/

2#1!

-B' ;5,9'0' ( )

-S5' '' 5,

-K5,67' '' ( )

- BB 5, ()

- ' 96 69'0 ()

-M' ()

-M'0 ( - )

-BAB 5>,5 ()

-BAK ( N )

KU SS

KS CM

T 1## / "# H7

N 8# / 56.

R 1 / 56.

S 3"?3 +C

M'' CA - / -

SI - / -

H697 PCH ( - )

SPO ( - )C',96+

BJ I - II ,57. M ( - )

% ( - )

P+

VB 6 ' R0 /

=0 -/-

A;9+5

BU ( ) NT ( - )

'' (-) '65 (-)

E95' '' -/-?

;'4'0 -/-

A,' H'7'

- TB @', BTA

() LLKB

- B2#

- C'9696'6 +,'

- P','@','5

65,6+, 5>

65+@'6

-PPCM

P9

P

-I A5,67

A6+69 2#7/

- D67+6 11 PO

- >5,6'+ 12'@

- %5'6>6 11"#

7

- PCT 6 3!##

- S@6,++'>+12! 7

- N6'6 9,+@

31>>

-R'6696 21 '@

- C,>' 31

- RH&E

3!#/3##/$!#/$!#

- M6+696 21

- M5>+;''6 6:

21'@

20


21/74

1"/11/

2#1!

-B' ;5,9'0' ( )

-S5' '' 5,

-K5,67' '' ( )- BB 5, ()

- ' 96 69'0 ()

-M' ()

-M'0 ( - )

-BAB 5>,5 ()

-BAK ( N )

KU SS

KS CM

T 12# / $# H7N 8# / 56.

R 1 / 56.

S 3"?3 +C

M'' CA - / -

SI - / -

H697 PCH ( - )

SPO ( - )

C',96+

BJ I - II ,57. M ( - )

% ( - )

P+

VB 6 ' R0 /

=0 -/-

A;9+5

BU ( ) NT ( - )

'' (-) '65 (-)

E95' '' -/-?

;'4'0 -/-

A,' H'7'

- TB @', BTA

() LLKB

- B2#- C'9696'6 +,'

- P','@','5

65,6+, 5>

65+@'6

-PPCM

P9

P

-I A5,67 A6+69 2#7/

- D67+6 11 PO

- >5,6'+ 12'@

- %5'6>6 11"#

7

- PCT 6 3!##

- S@6,++'>+

12! 7

- N6'6 9,+@

31>>

-R'6696 21 '@

- C,>' 31

- RH&E

3!#/3##/$!#/$!#

- M6+696 21

- M5>+;''6 6:

21'@

N. P$RTAN/AAN KAU

0. Ba"aimana dia"n%sa ada asien ini 1

D6'7+6 ;5,+6 9'@' 9657'' ;5,9'',' 75:'' 66? @55,6'' 66 /

:''6? @55,6'' ;'5,6++76? ,'96++76 9' @55,6'' @5:'7 '6*'? B5,9'','

75:'' 66 ;5,+6? 75:'' ,5@6,'+,6 ;5,@' ;' 3 677? 5,9'@' ;' 9','0? 9'

*5,6 9'9' 5,9'@' @'9' @'65. %5:'' 656 ;5,@' 95' 9' 5,67' '' 5,' ;5,'

21


22/74

;'9' *'7 5, :7' 5,9'@' @'9' @'65. D6'7+6 @'9' @'65 66 ;5,9'',' 0'6

@55,6'' 9'0' (BTA) '9''0 T;5,+6 P', BTA 234? ',5' 0'6 @55,6'' 2

@565 9'0' 5:' BTA ( ) ? 7';',' ,'96++76 5:' 7';','

;5,+6 '6. L' 56 *'7 '@' @'9' ++ +,' 5@567' @57+;''

96*''' lesi luas? ',5' @,+5 5;60 ' 9',6 56 66'? *'6 ;6' @,+5 575'6

5;'76' 9',6 ' '' 9' @', 957' ' 69' 5;60 9',6 6+ 9',6 67' 59' 95@' 9' @,+5 @6+ 9',6 ' 5@60' @'9'

69'0 (>'9696'6 +,')? '' >57. P'9' @55,6'' ';+,'+,6 969'@'' 0'6 '6 HIV

,5'6. P5, @55,6'' ';'0' *'6? CD.

D6'7+6 CHF 5> PPCM 96 ''' @'9' @'65? ',5' 96 9'@'' '9'*' ,64'*'

5' '@' *'7 5;5,' 9' >5@' 5'0 55'0 ;5,6


23/74

!#>> # /2 :'

2.###>> / 2 :'

T55/56

(K5;0' >'6,' F'+, 55) :'0 55'/56

(J'0 :' "# 56)

I 5 O' (2.### 1!) 3#.### 2# 55/56

(2 "#) 1.#

I 5 T5,+ (2.### 2#) #.### 2$ 55/56

(2 "#) 1.#

23

- I+6'69 3## 7 11 PO

'6;6+6 957' '65,'' 5@5,6 ' 9' '0? 7'77' 76 0'6?

@5,'0 96'@+,' 6;*' 65,? @,@,'? ,5'6 06@5,566


24/74

24

- P6,'6'69 $!# 7 11 PO

P6,'6'69 '6 9'' ''' '' 5,0'9'@ 6+;'5,6. P6,'6'69 ;5,6' ;'5,669

5,'' @'9' ;'6 ;5,+6 6,'5',.

E5 '@67 7'77' 76 0'6? '0,'76'? '+,56'? '? '0? 96,6'? ''65?95'.

- E';+ $!# 7 11 PO

E';+ 5@*'6 6' ;5,+'6. E';+ 69' 556 ' '6 5>'6

M. ;5,>+6 9' M. ''66. O;' 66 5'@ 55' @5,;0' ' ;5,+6 *'7

5'0 ,565 5,'9'@ 6+6'69 9' ,5@+66.

E5 '@67 E5 '@67 '' *'6 @5,' 5':'' @5760'' ;6''*' ;6'5,'

(5,66 ,5,+;;',) *'6 ,*' ':' @5760''? 06'7*' 5'@' 5;59''

4','? 575>6*' '@'7 @'9'7? 9' ++' 5,' '@ '5,'. E5 '@67 '6

*'6 ,' 6? 95'? @,,6? *5,6 596? 7'77' ',' @5>5,''? ''65? '6

5@''? 96+,65'6? 9' :7' 76 0'6'6 13

M6+696 21 (PO)

O;' 66 5,@'' '6-656 ('6-'76' @5+,6) '75 5';+6? 96,55@' '76'@5>+,6 9' @5*'6 M565,5. H' 66 :7' 965' 5;'7'6 +69'6 '' 5' 606;6+,. H'

66 567'' 76 :'7.

K%nt!aindikasiH6@5,566,>' 2##7

I96'6 A+,56'? 65,? ;'' ',' 5@59? '5+,5.

K+,'696'6 -


25/74

25

%5'6>6 11"# 7

%5'66 5,@'' ' '6;6+6' 7++7' '6+76+69' *'7 '6 570';'

'-' 7,'-@+66 '@ ' 7,'-57'6 5,' '-' *'7 ,5655,0'9'@ '66,+;' '6? 5@5,6 S'@0*+>+>> @570'6 @5666'5 P59++'

'5,76+' P,+5 K5;65' E.>+6. M5'65 5,:' ;5,9'',' @570';'' 65'

@,+56.

Indikasi:

I56 7,' 57'6 (P59++'? P,+5? S5,,'6') 9' %,' @+66 (S'@0*+>+>>)?656 '7? 656 ',' ''? 656 6 9' :',67' '? 656 ',' ,6?

';9+5? 59+',966 9' 5@656' ? @577'' +@6>'? 9' @,+6'6 ;'5,6

59+',966 9' 69'' ;59'0.

K%nt!aindikasi :

H6@5,566 5,0'9'@ %5'66 9' A6+76+69' '6

PCT 6 3!##

P','5'+ '9''0 9,65@' 5'6 ',' >5,'. K'9', '6 9''

@'' 96>'@'6 9'' 4' 3# 56 '@'6 "# 56 55'0 @5;5,6'. P','5'+

965,56' 5'6 76:'? ,'7 9',6 ! '@' 57''6 @5,;'0' 9' 5;'76' ;5',9'' ;5 5,+:7'6. S6' ''756 @','5'+ 9'@' 5706'7' ,'' *5,6 ,67'

'@'6 59'7. S6' '66''6*' '7' 5'0 50677' 50677' 69' 967'' 5;'7'6

'6,5'6.

Indikasi:

S5;'7'6 '6@6,56/''756? 5,' ;'76 @'65 *'7 69' '0' '5+'.

S5;'7'6 ''756? 6'*' 57,'76 ,'' *5,6 @'9' '6 5@''? '6 7676? '6

4' 0'69 9' '6 @'9' ++.5,' 95' @'9' 65' 9' 55'0 5'+ 9' 956656 7++5-"-+' 95069,+7''5.69' ;+50

967'' @'9' @595,6' 957' 7'77' 76 0'6.


26/74

26

-D67+6 11 ';5 (PO)

D67+6 5,@'' 76+69' :'7 *'7 ;5,'' 9',6 9676'6 ''' *'7 5666 55

6+,+@6 @+66 (567'' 5'' +,'6 ++ :'7). S5'6 6? 967+6 :7'5@*'6 55 ' '77 5,0'9'@ '6@ 5'9'6 '' 69' 5@'.

K%nt!aindikasi:I6656 76:' '? 5,'' 76:'? ',6' (69' 96;5*' 560 +50 76:')?

06@5,'56' ('9', K'6 9'' 9','0 96 '' +,').

M5>+;''6 6: 21'@

M5>+;''6? 5@*'6 '6',' ;6+66'? M5>+;''6 ;5,0;7' 5,' 957' @,+5 ,'56'6 5;'7'6 C+-5*

B12 *'7 5,9'@' 96 9'' 9','0? 9' 5,@'' 0+++7 >5@0'+@+,6 957' @5>, ' 9' 4' @50 566'6 8

:'. E56 5,0'9'@ 6,++,7'65 7,' @+66 9' 7,' 57'6. S';6 5,0'9'@ 56 ;5'

'>''5 *'7 960'6' ;'5,6.

I96'6 I56 ',' 560? 56766? 656 '7 9' :',67' '.

K+,'696'6 0*@5,5665,6'+ '' 7++7' 5'+@+,6

N6'6 9,+@ 31>>

N*'6 5666 '6++0*'

;'5,6) *'7 69' 5@*'6 5,+ @'9' 5;,' 5*'. H'6 9',6 6'' 66 5;'5;,' 69' 9'@' ;5,76 '76 5;'7'6 ,6'7' *'7 556 (55>657'0' ;'76 @'65 *'7 ,5' 656 :', +@6'

K%nt!aindikasi :P'65 *'7 06@5,566 5,0'9'@ N*'6


27/74

5. Ba"aimana !%"n%sis ada asien ini 1

+ '9 V6' 9;6' '9 ''

+ '9 F76+' '9 ''

+ '9 S''6+' '9 ''

TIN+AUAN PUTAKA

1.Tu)e!kul%sis 2TB#4

0.0 De,inisi

T;5,+6 (TB) 5,@'' '''0 550'' '*','' *'7 @567 96 96' 66.

P'9' '0 12 World Health Organization (=HO) 5'0 5>''7' ;5,+6 5;'7'6

lobal !mergenc" #. L'@+,' =HO '02#12 5*''' ;'04' 5,9'@' 8?$ :' ' ;',

;5,+6 @'9' '0 2#12? 96'' 3? :' '9''0 ' BTA (B'6 T'0' A') @+66.

S5@5,67' @599 96' 5'0 5,656 ' ;5,+6 9' 5, ,576+' =HO

:'0 5,;5', ' TB 5,:'96 96 A6' 577',' *'6 33 9',6 5,0 ' TB 96 96'?

' ;6' 9660'9',6 :'0 @5999 5,9'@' 182 ' @5, 1##.### @599. D6 A,6'

0'@6, 2 '6 5;60 ;5', 9',6 A6' 577',' *'6 3!# @5, 1##.### @5999. D6@5,6,''

'7' 5'6' '6;' TB '9''0 8### 56'@ 0',6 9' 2 - 3 :' 56'@ '0. L'@+,' =HO

'02#12 5*5;' ;'04' :'0 5,;5', 5'6' '6;' TB 5,9'@' 96 A6' 577','

*'6 3#.### +,'7 '' '7' +,'66 5;5', 3 +,'7 @5, 1##.### @599. A7'

+,'66 5,6776 5,9'@' 96 A,6' *'6 83 @5, 1##.### @599? 96'' @,5@ 6776 57'6;'' @567'' >5@' ' TB *'7 >.

27


28/74

D6 I9+56' ;5,+6 '9''0 @5;0 ++, ' 96'',' @5*'6 5', 9'

5,@'' @5*5;'; 5'6' ++, 67' 55'0 @5*'6 :'7 9' @5*'6 @5,'@''

' @'9' 5,0 ''7' 6'. T;5,+6 '9''0 @5*'6 *'7 965;';' +50 656

M"cobacterium tuberculosis >+@5. ;5,;5 ;''7 , '' 5966 5577? 69'

;5,@+,' 9' 69' ;5,'@. B'5,6 66 ;5,,' 5;', #?3 #?" 9' @':'7 1 .

D6967 M. tuberculosis '7' +@5? 5,96,6 9',6 '@6' 5' >@ 6776 ("#).

P5* '' 96967 5 M. tuberculosis 6''0 '' 6+'? 66 +@5 (>+@5-

4'5)? ,50'+' 966+' *'7 965; cord $actor? 9' m"cobacterial sul$oli%ids *'7

;5,@5,' 9'' '>' '' 5'6 (,566+ '9 657,)

2. S5;0 957' 5677'' 5966 ;5' ('',' '6 ','7 %0+? 7',6 6;,+6? ','7

@5,'@,' 96 06)

3. M5*5;', 957' >',' P5,+66'? 5>',' ;,++75? 05'+75 9' 6+75

D',6 ;5,+6 @,65, 66 '' > ;5,'0-'0 596' ;5,+6 @+-

@,65,? ;6''*' @'9' 6' 1!-# '0. T;5,+6 @+ @,65, 5@*'6 '' *'7

;5,'>' '>' *'6 ;5,+6 ;5 954''? localized tuberculosis? ;5,+6

5'0? 9' 5;'7'6*'. B5 ;5,+6 66'0 *'7 5,'' 5:'96 @,+;5 550''

28


29/74

,'*'? ',5' 9'@' 5:'96 ;5, @5','. T;5,+6 @+-@,65, 96'6 957' ','7

966? *'7 *' 5,5' 96 575 '@6' 9',6 +; @5,6+, '@ +; 65,6+,. S','7

966 66 '4'*' ;5,;5 ' ','7 @5+6 5>6.$

0.6 KLAIFIKAI TUB$RKUL(I PARU

P55' '66'6 @5*'6 9' 6@5 @'65 ;5,+6 55,' ' 95666 '

*'7 56@6 5@' 0'? *'6

1 B5,9'',' 5' ''+6 @5*'6

2 B'5,6++76 0'6 @55,6'' 6,++@6 BTA @+66 9' BTA 57'6

3 R64'*' @57+;'' TB 5;5*' ;', '' 9'0 @5,'0 96+;'6

S' HIV @'65

M''' 9' :' 55' '66'6 9' 6@5 '9''0

1. M55' @'9' @57+;'' *'7 5'6

2. R576,'6 ' 5>',' ;5',

3. M55' @,6+,6' @57+;'' TB BTA @+66

. A'66 +0+, 0'6 @57+;''

K55'6' @'9' 9' 9+6 @57+;'' 957' '57+,6 96'7+6 '7' 96@5,'

1 M57069',6 5,'@6 *'7 69' '95' (undertreatment) 50677'

2 M5>57'0 6;*' ,5656?

3 M57069',6 @57+;'' *'7 69' @5, (overtreatment) 50677'

M567'' @5''6' ;5,-9'*' 5;60 ;6'*' 556 (cost&e$$ective)

! M57,'76 55 '@67.

a. Klasi,ikasi )e!dasa!kan letak anat%mi yan" te!kena:

1 T;5,+6 @',. T;5,+6 @', '9''0 ;5,+6 *'7 5*5,'7 :',67'

(@',56) @',. T69' 5,' @5,' (5'@ @',) 9' 55:', @'9' 06.

29


30/74

2 T;5,+6 5,' @',. T;5,+6 *'7 5*5,'7 +,7' ;0 '6 5'6 @',?

6'*' @5,'? 5'@ +'? 5'@ :'7 (@5,6>',96)? 55:', *5? '7?

@5,596'? 6? ? 76:'? ',' 5>67? '' 5'6? 9' '6-'6.

T;5,+6 5,'-@', 96;'76 ;5,9'',' @'9' 67' 5@','0' @5*'6*'?

*'6

1 TB 5,'-@', ,67'

M6'*' TBC 55:', 65? @5,66 59'6'6 '7

;5''7)? 596? 9' 55:', '9,5'.

2 TB 5,'-@', ;5,'

M6'*' 56766? 665,? @5,6',966? @5,6+66? @5,66 59'667 9' '' 5'6.

). Klasi,ikasi )e!dasa!kan hasil eme!iksaan BTA sutum

' T;5,+6 @', BTA ( ) '9''0

6 S5,'7-,'7*' 2 9',6 3 @565 9'0' 5:' 0'6 BTA

@+66

66 H'6 @55,6'' ' @5>65 9'0' 5:' 0'6 BTA @+66

9' 5'6' ,'96++76 5:' 7';',' ;5,>+6 '6

666 H'6 @55,6'' ' @5>65 9'0' 5:' BTA @+66 9'

;6'' @+66

; T;5,+6 @', BTA (-)

6 H'6 @55,6'' 9'0' 3 '6 5:' BTA 57'6? 7';','

66 9' ,'96++76 5:' ;5,+6 '6

66 H'6 @55,6'' 9'0' 3 '6 5:' BTA 57'6 9' ;6''

M"ccobacterium tuberculosis@+66 11

-. Klasi,ikasi )e!dasa!kan !iwayat en"%)atan se)elumnya

K'66'6 ;5,9'',' ,64'*' @57+;'' 5;5*' 96;'76 5:'96 ;5;5,'@' 6@5

@'65? *'6

1 K' ;',

A9''0 @'65 *'7 ;5 @5,'0 96+;'6 957' OAT '' 9'0 @5,'0

55' OAT ,'7 9',6 ' ;' ( 677).

2 K' ';0 ('ela%s)

30


31/74

A9''0 @'65 ;5,+6 *'7 5;5*' @5,'0 59'@' @57+;''

;5,+6 9' 5'0 96*''' 5;0 '' @57+;'' 57'@ 9696'7+6

5;'6 957' BTA @+66 ('@' '' ,).

3 K' 55'0 @ ;5,+;' ((e$ault )

A9''0 @'65 *'7 5'0 5:''6 @57+;'' 66' 1 ;' 9' @

;5,+;' 2 ;' '' 5;60 957' BTA @+66 '' BTA 57'6.

K' 55'0 7'7' ()ailure)

A9''0 @'65 *'7 0'6 @55,6'' 9'0'*' 5'@ @+66 '' 5;'6

5:'96 @+66 @'9' ;' 56' '' 5;60 5'' @57+;''.

! K' P69'0' (*rans$er +n)

A9''0 @'65 *'7 96@69'0' 9',6 UPK *'7 5666 ,5765, TB '6

5':' @57+;''*'.

" K' '6

A9''0 5' ' *'7 69' 5506 55' 96''. D'' 5+@+ 66

5,' K' K,+6? *'6 @'65 957' 0'6 @55,6'' '60 BTA @+66

55'0 55'6 @57+;'' '7'.

#atatan:

TB @', BTA 57'6 9' TB 5,' @',? 9'@' :7' 57''6 ';0? 7'7'? 95' '@

5:'96 ' ,+6. M56@ '7' :','7? 0', 96;6' 5>',' @'++76? ;'5,6++76

(;6'')? ,'96++76? 9' @5,6;'7' 596 @56'66.

) Be!dasa!kan !iwayat enyakit HI7 asien

HIV @+66

HIV 57'6

0.6. MANIF$TAI KLINI

P595,6' TB @', '' 57''6 ;5,;'7'6 7'77' 550''? 5@5,6 ;' ;5,9'0'

,+6? 95' ;5;,6? ;5,5,67' '@' 5;'; 96 '' 0',6? 5' '@'? *5,6 9'9'? 9'

31


32/74

@5,' ' ''. S5'*' 6 9'@' 5,' @,+96+6 969'',' @'9'

Anamnesis dan eme!iksaan ,isik

P'9' @55,6'' 66 9'@' 965' '9'-'9'

'. T'9'-'9' 66,' (,59@? ;,+>06'? ,+06 ;''0).

;. T'9'-'9' @5',6' @',? 96','7'? 9' 596'6.

>. S5>,5 96 ',' '' 9' ,+06.

9. S',' '' '+,6 ',5' '9'*' '


33/74

P'9' @55,6'' :''6 5'6' *'7 '' 96:@'6 5,7'7 9',6 +,7' *'7

5,6;'

Peme!iksaan Bakte!i%l%"ik

B'0' @55,6''

B'0' @55,6'' ;'5,6++76 66 9'@' ;5,'' 9',6 9'0'? >'6,' @5,'?

li-uorcerebros%inal? ;6'' ;,+? ;6'' ';7? ,'' ;,++'0*) '' ;5,;5,>' (+9',).

>. A9'*' '


34/74

0.. TATALAKANA

Tu*uan Pen"%)atan

P57+;'' TB ;5,:' 5*5;0' @'65? 5>57'0 5'6'? 5>57'0

5';0'? 5' ,''6 @5',' 9' 5>57'0 5,:'96*' ,5656 ' 5,0'9'@

OAT.

P!insi en"%)atan

P57+;'' ;5,+6 96'' 957' @,66@ - @,66@ 5;'7'6 ;5,6

OAT 0', 96;5,6' 9'' ;5 +;6'6 ;5;5,'@' :56 +;'? 9'' :'0

>@ 9' 9+6 5@' 5'6 957' '57+,6 @57+;''. J'7' 7'' OAT

77' (++5,'@6). P5''6' OAT-K+;6'6 D+6 T5'@ (OAT-KDT) 5;60

577' 9' '7' 96':,'. U 5:'6 5@'0' @'65 55' +;'? 96'' @57'4'' '77

(DOT (irectl" Observed *reatment) +50 5+,'7 P57'4' M55' O;' (PMO).

P57+;'' TB 96;5,6' 9'' 2 '0'@? *'6 '0'@ 656 9' ':'.

Taha awal 2intensi,4

34


35/74

P'9' '0'@ 656 ('4') @'65 59'@' +;' 56'@ 0',6 9' @5, 96'4'6 5>','

'77 5>57'0 5,:'96*' ,5656 +;'. B6' @57+;'' '0'@ 656 5,5; 96;5,6' 5>',' 5@'? ;6''*' @'65 5',

5:'96 69' 5', 9'' , 4' 2 677.

S5;'76' ;5', @'65 TB BTA @+66 5:'96 BTA 57'6 (+57'0 5,:'96*'

5';0'11

Paduan (AT yan" di"unakan di Ind%nesia

P'9' OAT *'7 967'' +50 P,+7,' N'6+' P5'77'7' T;5,+6 96

I9+56' K'57+,6 1 2(HR&E)/(HR)3.

K'57+,6 2 2(HR&E)S/(HR&E)/!(HR)3E3.

D6'@67 59' '57+,6 66? 96596'' @'9' +;' 66@' (HR&E)

K'57+,6 A' 2HR&/HR

P'9' OAT '57+,6-1 9' '57+,6-2 96596'' 9'' ;5 @'5 ;5,@' +;'+;6'6 9+6 5'@ (OAT-KDT)? 59'7' '57+,6 '' 55',' 66 96596''

9'' ;5 OAT +;6@'.

T';5 OAT KDT 66 5,96,6 9',6 +;6'6 2 '' :56 +;' 9'' ' ';5. D+6*'

965'6' 957' ;5,' ;'9' @'65. P'9' 66 965' 9'' ' @'5 '

@'65.

P'5 K+;6@'.

A9''0 @'5 +;' 5@' *'7 5,96,6 9',6 I+6'69? R6'@66? P6,'6'69 9'

E';+ *'7 965' 9'' ;5 ;65,. P'9' OAT 66 96596'' @,+7,'

967'' 9'' @57+;'' @'65 *'7 57''6 55 '@67 OAT KDT.

35


36/74

P'9' O;' A6 T;5,+6 (OAT) 96596'' 9'' ;5 @'5? 957' :'

59'0' @5;5,6' +;' 9' 5:'6 5'77' (+66') @57+;'' '@'6

55'6. S' (1) @'5 ' (1) @'65 9'' ' (1) '' @57+;''.

KDT 5@*'6 ;5;5,'@' 57' 9'' @57+;'' TB

1 D+6 +;' 9'@' 965'6' 957' ;5,' ;'9' 50677' 5:'6 5566' +;' 9'

57,'76 55 '@67.

2 M5>57'0 @577'' +;' 77' 5067' 5,' ,56+ 5,:'96*' ,5656 +;'

7'9' 9' 57,'76 5''0' @56'.

3 J'0 ';5 *'7 965' :'0 5;60 5966 50677' @5;5,6' +;'

5:'96 595,0'' 9' 567'' 5@'0' @'65

Paduan (AT dan e!untukannya.

a. Kate"%!i;0 25HR


37/74

6. HI7= AID

2.1 D5666

HIV (Human +mmunode$icienc" Virus) '9''0 ' ,5,+


38/74

5@65? 5 959,66 (@'9' +' ;0 '6')? 5 L'75,0' (@'9' 6)? 5

6,+76'? 9' ;5,;'7'6 :',67' ;0.1

S5 6+6 CD (T hel%er) ;5,@5,' 5;'7'6 @57', '' ,5@+ 6?

5,'' 5'6 5,56 6+6. S5 CD :7' 575',' '+, @5,;0'

5 B 570'6' '6;+96 9' 575',' '+, @5,;0' 5 T

567'' '6


39/74

2. D6'7+6

T5,9'@' 9' :6 *'7 0' 967'' 59556 '6;+96 5,0'9'@ HIV.

P5,''? 5 ELISA (enz"me&linked immunosorbent assa") *'7 ;5,5'6 5,0'9'@

'6;+96 9'' 5,. A@';6' 0'6 ELISA @+66? 96+6,'6 957' 5 59'

*'7 5;60 @566? *'6 Western blot. B6' 0'6*' :7' @+66? 96'' 5 '7

',5' :6 66 9'@' 5;5,6' 0'6 @+66-@' '' 57'6-@'. B6' 0'6*'

5'@ @+66? @'65 96''' 5,+@+66 HIV. P'9' '0'@ 66 96'' @55,6''

66 9' 6++76 '6 575


40/74

- D5' ;5,5@':'7' '@' 5;'; 1 ;'

- C'9696'6 +,'

- O,' 0'6,* 5+@'6'

- TB @',

- I56 ;'5,6 ;5,' (@5+6'? @*+6+66)

D'/''4er$ormance scale3 ;59,5 G !# 9 50',6 1 ;'

5,'06,

Taha 8:

- HIV 4'67 *9,+5 (@5,' ;; 1#? 96',51 ; ''

5'0 5 9' 95' 1 ;)

- P5+666 >',6' @5+6'

-T++@'+6 +'

- K,6@+@+,696+6 957' 96',5? 5;60 9',6 5;'

- K,6@+++6? 5,' @',

- TB 5,' @',

- P5*'6 965;';' +50 CMV

- K'9696'6

- M6+;'5,6+6 '6@6'

- L*@0+'

- K'@+6 ',>+'

- HIV 5>5@0'+@'6

- I56


41/74

5>',' 9,''6 5:' @5,' '7' +,'6' 9' +,;696' '6;'

HIV/AIDS.1!

P5;5,6' ARV ;5,7'7 @'9' 67' @,+7,566' @5*'6? *'7 9'@' 966'6

5'6 '9', CD 9' '9', RNA HIV 5,. T5,9'@' 67' :56 '6,5,+udine 26T#4 1!#7 2/0',6 '' 3##7

1/0',6

ta>udin 2d8T4 #7 2/0',6 (3#7 2/0',6 ;6';;G"#7)

udin 2e!se

T!ans-!itase Inhi)it%!

2NNRTI4

$,a>i!en? 2$F74 "##7 1/0',6

41


42/74

Ne>i!aine 2N7P4 2##7 1/0',6 1 0',6

596' 2##7 2/0',6

P!%tease Inhi)it%! 2PI4

Indina>i!=!it%na>i!

2ID7=!4

8##7/1##7 2/0',6

L%ina>i!=!it%na>i!

2LP7=!4

##7/1##7 2/0',6

Nel,ina>i! 2NF74 12!#7 2/0',6

a@uina>i!=!it%na>i!

27=!4

1###7/ 1##7 2/0',6 ''

1"##7/ 2##7 1/0',6

Rit%na>i! 2RT7=!4 K'@ 1##7? ',' +,'

##7/!

P'9' L66 P5,''

S' +;6'6 +;' *'7 967'' @'65 *'7 ;5 @5,'0 59'@''

ARV 5;5*'? *' 66 @5,'' *'7 96;5,6' 5,96,6 9',6 2 NRTI 9' 1

NNRTI. A9' @'9' U'' 66 @5,''

A&T-3TC-NVP

A&T-3TC-EFV

DT-3TC-NVP

DT-3TC-EFV

3TC 5' 967'' 9' 96'' 5 9'' ,5765 (5' 96>''

96 57'0). O;' *'7 @5,'' '9''0 A&T '' DT (69' ;+50 96;5,6'

;5,'''). O;' *'7 5,'06, NPV '' EFV (69' ;+50 96;5,6' ;5,''').1!

6. TUB$RKUL(I HI7 2TB;HI74

3.1 H;7' TB 9' HIV

42


43/74

Jumlah kasus TB BTA +

Faktor lingkungan:

!ntilasi

"!#a$atan

%alam ruangan

Faktor #!rilaku

&isiko m!n'a$i TB (ila $!ngan )*:

510, s!tia# tahun

- 30, li.!tim!

%iagnosis t!#at $an /!#at!ngo(atan t!#at $an l!ngka#

"on$isi k!s!hatan m!n$ukung

alnutrisi

!nakit % imunosu#r!san"!t!rlam(atan $iagnosis $an #!ngo(atan

Tatalaksana tak m!ma$ai

"on$isi k!s!hatan

"ons!ntrasi "uman

ama "ontak

)* +

T&AJA*F"* AT*TB

B)

10,

transmisi

I56 HIV ;5,': 9' 66' 5,? @'65 5:'96 ,5' 5,0'9'@ ;5,;'7'6

656. B5;5,'@' 96 '','*' '9''0 TB? @5+6'? 656 :', 96 6 9'

+,+',67? 5,' 05,@5 +5,. I56 5,5; 9'@' 5,:'96 @'9' ;5,;'7'6 '0'@ 656

HIV 9' 6+@,56. F'+, *'7 5@57',06 576' 55+,'7 5:'96

@'65 TB '9''0 9'*' '0' ;0 *'7 ,59'0? 96 '','*' 656 HIV/ AIDS 9'

',66 (766 ;,). HIV 5,@'' '+, ,66+ @'67 ' ;'76 *'7 5,656

TB 5:'96 '6 TB. M5, =HO? 656 HIV 5,;6 5,@'' '+, *'7

59'0' 5,:'96*' @,+5 @'9' +,'7 *'7 5'0 5,656 TB? 567''

,66+ TB '5 5:'96 TB '6 9' 5';0'? 5*6' 96'7+6? 9'

5@5,;, 67'. TB :7' 567'' +,;696' 9' +,'6' @'9' @'65

@5769'@ HIV.1$

F'+, R66+ K5:'96' TB

3.2 P'+7556

P'9' +,'7 *'7 6++@55? 56' 5,656 M. tuberculosis, +,7'65

96':6' 5@'9' ',+'7 5'6 6756 96'' 55'0 96@,+5? '675

43

transmisi


44/74

6+;'5,6 96':6' 5 5-T. S5 CD 575',' 6+6 *'7 567''

'@'6' ',+'7 55' 9' 5;0 6+;'5,6. P'9' 5;'76' ;5',

+,'7 5,:'96 656 9' TB 69' ;5,5;'7? 56 5:'0 ;'6 5'@ 9+,'

;0. H'*' 1# 9',6 ' *'7 ;5,5;'7 5:'96 TB 66? 575,' 55'0

656 @,65, '' ;5,'0-'0 596' 5;'7'6 ,5'66,6 656 HIV. D676

66 @'9' +90' (+,'7 957' HIV 9' AIDS) 5;'7'6 @,596@+66 5,:'96*' 656

TB ;'6 @,65, '@ ,5'6


45/74

66' 5, 9'' 5>57'0 @5,;0' 9' @5*5;',' +' ;'5,6

5,5;.1$

B5,6 66 '9''0 0'-0' *'7 @5, 965'06 9'' 96'7+6 @'9'

@'65 TB 957' HIV 1$

6. %';',' 66 TB @',? 7';',' 66 TB @', 5>',' 96'4'6957' ;' 5;60 9',6 2-3 677? 59'7' TB @'9' @'65 HIV/AIDS

;' ;' 5,@'' 75:'' . P'9' TB 957' HIV 95' 9'

@5,' ;5,' ;'9' 5,@'' 75:'' *'7 @567.

66. S@ BTA? ',5' 6*' 96'7+6 TB @', @'9' @'65 HIV 5>','

66 9' @55,6'' @ BTA 5;60 5,67 965'' BTA 57'6?

'' 96@5,' @55,6'' , BTA. P55,6'' ;6'' @

5,@'' ;' 5' 596'7+6 TB @',. P'9' ODHA 957'

75:'' 66 TB @', *'7 0'6 @55,6'' 6,++@6 9'0' BTA *'

57'6? @55,6'' ;6'' 9'0' '7' 96':,' ',5' 0' 66 9'@'

5;' 96'7+6 TB @',. S5'6 6? @55,6'' ;6'' 9'

,5656 :7' 96'' 575'06 '9'*' MDR-TB? 96''

@'65 HIV 5,@'' ''0 ' '+, ,66+ MDR-TB. D'' ,'7'

5@5,;'66 '' ''' @'65 TB-HIV? '06,-'06, 66 5'0 965'

'' @5:'7 TB 5>',' 5@' *'6 , ,5656 BTA 957'

%55@5,? ' '' 5,5; ;5 '9' 9656'@ '*'' 550''?

0'*' '9' @'9' 5,' '*'' *'7 96,5+59'6.666. F++ +,'? 7';',' ++ 0+,' ;5,


46/74

' @'9' @'65 957' HIV @+66 96'55, ! 9'0 9'@'

96*''' @+66. @'9' @'65 @5 TB @', 5;'7'6 '' ;'

96'7+6 TB @', 69' 96,5+59'6' '76 ',5' 9'@' 5*5;';'

96'7+6 TB 5,';' 957' +556 @57+;'' :7' 5,';'

50677' 567'' ,66+ 5'6'. P577'' '6;6+6 6++

5;'7'6 5,'@6 656 595, @'9' TB 957' HIV @+66 0',

96069',6 5;'; 7++7' '6;6+6 66 ,5@+ 5,0'9'@ 6+;'5,6

TB 50677' 960'4'6,' 5706'7' 75:'' 55','. D6'@67

6 960'4'6,' 6;*' ,5656? 55',' '6;6+6> 7++7'

6++ 96>'9'7' 5;'7'6 OAT 66 59'. 18

3. P5''''''

P'9' 9'',*'? @,66@ @57+;'' TB 957' HIV/AIDS '' 957' @57+;''

'@' HIV/AIDS. N'? @57+;'' @'65 957' +656 TB-HIV 5;60 6

9',6@'9' TB @'9' @'65 '@' HIV. P'65 TB-HIV 5666 65 66' *'7

,59'0 9' 5,67 965' '9'*' 656 05@'66 9' '6*'? '' ''

@57+;'' 5,67 6; 55 '@67 9' 65,'6 +;' 50677' 5@5,;,

+966 @'65 5,' +;'-+;' 0', 96056' '' 96,'76 9+6*'. K+966

5,5; 5*5;';' @57+;'' 5:'96 5;60 @':'7 5,' 5@'0' @'65 5,67

5,7'77.1$

46


47/74

P,66@ @57+;'' '9''0 577'' +;6'6 ;5;5,'@' :56 +;' 9''

:'0 >@ 9' 9+6 5,' :'7' 4' *'7 5@'2. P,66@ @57+;'' @'65 TB-

HIV '9''0 '9''0 957' 59'0' @57+;'' TB. P57+;'' ARV

(ntiretroviral) 96'6 ;5,9'',' '96 66 HIV 957' '9', =HO. 1$

P57+;'' OAT @'9' TB-HIV

3..1 P5;5,6' 6'5'+ @'9' @'65 HIV/AIDS '7' ;5,;'0'*' ',5' ''

5*5;';' 55 +6 ;5,' @'9' 6.

3..2 I:56 ,5@+66 0'*' ;+50 96;5,6' :6' 5,596' '' 6 5'6 @''6

*'7 5,6.

3..3 D556'6 +;' (INH? ,6'@66) 69' ;+50 96'' ',5' 57'6;''

+6 *'7 5,6 @'9' 0'6.

3.. P'9' @'65 TB 957' HIV/AIDS *'7 69' 5;5,6' ,5@+

@57+;''? 5'6 96@66,' 5,9'@' ,5656 5,0'9'@ +;'? :7' 0',

96@66,' 5,9'@'*' '';+,@6 +;'. P'9' @'65 HIV/AIDS 5,9'@'

+,5'6 '',' 6+@,56 *'7 ;5,' 957' 95,':' @5*5,'@'? ',5'*'

9+6 '9', OAT *'7 965,6' ; +@6' 50677' +5,'6 +;' ,59'0

9'' 5,.

I5,'6 +;' TB 957' ARV

3..! P5''6' +;' HIV/AIDS 6'*' 69+',' ;5,''' 5;'

@'65 55' +;' 9'' :'0 *'7 ;'*' 50677' 9'@' 5,:'96

47


48/74

569'@'0'? +@6'6? 55 '@67? 65,'6 +;' 9' +mmune

'econstitution +n$lamator" S"ndrome (IRIS) S69,+5 P560' K55;''

(SPK) '' 965' 957'+mmune 'econstitution +n$lammator" S"ndrome''

IRIS '9''0 5+5' 6++76 ;5,@' @5,;,' 66 5,' 6;*'

75:'' 656 +@+,66 '6;' @560' 6 *'7 ;5,5;60' @'9' ''

ODHA 57''6 @5,' :'0 ++0

5,5,67 9',6 '65'6 IRIS '9''0 05,@5 +5, '' TB *'7 5,:'96.

3..1# S56'@ @595,6' TB-HIV 0', 96;5,6' @,+6'6 +,6+'+ 957' 9+6

"# 7/0',6 (9+6 77') 5'' @5;5,6' OAT.1$

=HO 55'@' @567*' ,'576 5;5 @5;5,6' ART? ,'576

66 96''' T0,55 I *'6

1) +ntensi$ied *uberculosis 5ase )inding? *'6 59556 5>',' '6

576' '9'*' 656 TB @'9' @'65 HIV.

6/ +soniazid 4reventive *hera%"? *'6 5;5,6' INH @'9' @'65 HIV()

957' TB (-) @5>57'0' 656 TB (96 I9+56' ;5

966@55'6')

7/ +n$ection 5ontrol, *'6 57+,+ 9' 5759'6' 656 TB 96

F'*'5 /F'66' @5'*'' 550''

S'9', U P5'7'' TB D57' I56 HIV(+nternational Standard )or

*uberculosis 5are )

S'9', 1

U:6 HIV 9' +567 0', 96,5+59'6' @'9' 5' @'65 *'7

595,6' '' *'7 9697' 595,6' TB. P55,6'' 66 5,@'' ;'76'

@567 9',6 '':55 ,6 ;'76 5' @'65 96 9'5,'0 957' @,5


49/74

S5'.@'65 957' TB 9' 656 HIV 50',*' 965''' *'7 5@' 57'5 +;' '6,5,+57'0' 656 '6*'.

S'9', 1"

P'65 957' 656 HIV *'7? 55'0 965


50/74

3..11 P'65 T; 5,'@', ,5765 "- ;' 96,5+59'6'.

3..12 U TB @'9' S65 ',' @' (;5,+' '' 56766) 9' TB

'7 9' 596 96,5+59'6' -1 ;' 5,'@6.

II. TB @'9' O'

3..13 U 56766 TB 96;5,6' 2RH&E/$-12RH 9' 95'50'+

57,'76 6''6 96 +' (69' HIV @+66).

3..1 I96'6 @5;5,6' +,6+5,+69 56766 TB @567''

5'' 6,','6'? 595' 5,5;,6? 9566 5,++76 +'? 069,+5'?

6', 9' '9'*' 56766 ;''6.

3..1! B6' 5,9'@' @ +;' 96;5,6' OAT '57+,6 2 *'6 2RH&ES/$-12RH

' 6'6 ,5@+ 5>',' 661$

E5 S'@67? I5,'6 O;' 9' P5'7''*'

Tanda 'e*ala Penan"anan

An%!eksia mual dan

nye!i e!ut

T5' +;' 55'0 ''. J6' @'9'

+;' ART 57'97 A&T? :5''

5@'9' @'65 ;'04' 66 ;6''*' ''

06'7 596,6. A'6 50' 66

6+'6. T';5 INH 9'@' 96;5,6'

'' 5;5 69,.

Nye!i sendi B5,6 ''756? 6'*' '@6,6 ''

@','5'+.

Rasa kesemutan E5 66 +50 ',5' INH 96;5,6 ;5,''

99I '' DT. B5,6' ';'0'


51/74

'' 06'7? :6' 2 7? ,:.

Dia!e B5,6 +,'6 9' ''''' 96',5?

*'6' '' ',5' +;'? ''

5;'6 9'' ;;,@ 677.

Kelelahan P66,' '56'? 5,'' +50 ',5'

&DV. P5,6' HB? 55'0' ;6'' 5,:'96

-" 677 55'0 @577'' &DV? :6'

-" 677 96,:.

Te"an" mimi )u!uk M76 965;';' +50 EFV? ''

+567 9' 97'? 9'@' 06'7 G 3

677. R: @'65 '@';6' '9'

7'77' ++9 '' @6+6? '' 6

'4' ''6 957' '6,6@66 @'9' ''

0',6.

Kuku

ke)i!uan=kehitaman

Y'6' @'65 5;'7'6 '6;'

@57+;'' &DV.

Pe!u)ahan dalam

dist!i)usi lemak

D66' 957' @'65? 5;'7'6 55

'@67 DT.

'atal atau keme!ahan

ada kulit

J6' 5*5,0 '' 575@'? +@

+;' TB 9' ART? ,: @'65. J6' 9''

@57+;'' NVP @5,6' 9' 566

'@''0 56*' 5,67 (576'

'5,76) '' ;''0 (576' 5


52/74

Muntah )e!ulan" P5,6' @5*5;'; '0? ''

@55,6'' 76 0'6? :6' 5,:'96

05@'++6 056' OAT 9' ART?

,: @'65.

Pen"lihatan )e!ku!an" H56' EMB? 6' @59'@' '06/,:.

Demam P5,6' @5*5;'; 95' 9'@'

965;';' +50 55 '@67 +;'?

656 +@+,66? 656 ;', ''

IRIS? ;5,6 @','5'+ 9' 6' @59'@'

'06.

Pu-atanemia U, '9', HB 676,' 656

+@+,66? @'65 96,: 9' +@

&DV/967'6 DT.

Batuk atau kesulitan

)e!na,as

K576' IRIS '' 656

+@+,66? 6' @59'@' '06.

Lim,aden%ati K576' IRIS '' 656

+@+,66? 6' @59'@' '06.

8. P$RIPARTUM #ARDI(MI(PATI

8.0 De,inisi

K',96+6+@'6 @5,6@', '9''0 7'77' @'9' :'7 *'7 5,:'96 5'' @5,6+95

@5,6@',. H' 66 96'9'6 957' 9676


53/74

*'7 965:56' 9' 95* :'7 :7' 5,:'96. R''-,'' 5'' 9','0 5966 567'?

59'7' @5;0 9','0 ,65 57'++9'6 567'*' '6,' 9','0. S5''

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" 677 55'0 5'06,'. B5;5,'@' 0+,+ *'7 965@'' 9',6 ,'06? 76:'? :'7?

9' @',-@', ;5,59', 96 9'' 9','0 9' 5,'7'7 @5,;'0' 66.18

8.5.Dia"n%sis

U 557'' 96'7+6 ',96+6+@'6 @5,6@', *'618

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8.6.Fakt%! !esik%

B5;5,'@' '+, ,56+ *'7 ;5,0;7' 957' ',96+6+@'6 @5,6@',18

U, 50'6' 3# '0

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H6@5,56 @'9' 50'6'

P,667,'


54/74

'@'6 $! '. I6 76 965;';' +50 @5*'6


55/74

8.C Peme!iksaan Penun*an"

T5 ';+,'+,6 9','0 5,@'' ;'76' '9', 9',6 5',6 @5;5',' :'7 9' >'6,' 96 @',-@', .

CT >' 0+,' 5*676,' 7@'' 9','0 96 @',-@',? *'7 9'@' 5,:'96 5''

'' 575,' 55'0 50'6' 9' 5*5;';' 75:'' 6,6@ 957' ',96+6+@'6

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';+,'? 9' 5*676,' 5,'7' :'7.

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;6''*' 96'' 56'6 ,5@+ 5,0'9'@ 5,'@6 596 9' 5''

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56/74

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76 76:' 9' '9', '6 @5, 96@'' 5'' 5,'@6.

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;'4'0 2## 5/3. Viral load5:' :'0 HIV 96 9'' 9','0 9' :'0*' *'7

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57'6;'' 0'@6, 8# 5'6' @'9' @'65 AIDS. A',' 656 +@@+,66 *'7

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59/74

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0. T!ansmisi eksual

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1.

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6. T!ansmisi T!anslasental

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A. KURAN% ENER%I DAN &AT %I&I MAKRO

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63/74

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B5;5,'@' @5566' 5'@+,' ;'04' @5;5,6' F5 9'@' 5*5;';' 6@6'6 '

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C. PERAN %I&I DALAM PENYEMBUHAN PASIEN TUBERKULOSIS

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3. P6,'6'69

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B. ALUR PELAYANAN %I&I

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1. P5'

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C. PROSES ASUHAN %I&I TERSTANDAR (PA%T)

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1) A'

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69/74

P57,' '577'' I95 M'' T;0 (IMT)? '' '@';6' @'65 69' 9'@'

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70/74

;. B6+66'

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2.) A;6? '6'*' 957' ,'@+, @,+56 9','0

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>. K66

P55,6'' 66 5,'6 766 *'7 @567 96':6 @'9' @'65 ;5,+6 '',' '6

1.) D5'57'6;''@567''5;0'766

2.) P5,' N' M'' 5@57',06 :'0 '@' ''' *'7 96+6

3.) M' 5,@'' 55 '@67 +;' 9' 75:'' ++,;69 9'@' 5@57',06 '@'

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".) B' 5@57',06 :'0 '@' ''

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72/74

K$IMPULAN

1 %';',' 66 @'65 TB 957' HIV/AIDS 5,7'7 9',6 95,':' ;5,' ,67'*'.

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66 5:'96 69' 0' '76.

2 %5:'' 66 57','0 9' '' >,67' @'9' TB-HIV? ;6' 96:@'6 @,+5 @5,;,'

66 *'7 ;5,'77 '7' >5@'. M6'*' 5'9'' 5, 9,'6? 95'

6776? 9' '' 6;*' 5' '' *'7 ;' +50 ',5' ;,++@'5 *'7

96'9'6 ;*6 405567.

3 P55,6'' @ BTA 5'@ 5,@'' @55,6'' @'67 @567 9'' @557''

96'7+6 TB? 4''@ 96 9'5,'0 957' @,5 @'9' @'65

*'7 59'@' ARV? 0' 66 76 5'9'' 57''' 5,'@6 9',6 ,5765 ARV?

9'/'' ,5656? '' TB *'7 5,54' 96'7+' @'9' ,667 '4'.

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I5,'6 '', OAT 9' ARV? 5,'' 55 0'@'++66'*'? 0', '7'

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9657''? '' +;' ARV 5'@ 965,' 957' 5


73/74

1. =+,9 H5'0 O,7'6'6+. %+;' T;5,>+6 >+,+ 2#12 5@6956++7*? ,'57*?

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". KEMENTERIAN KESEHATAN RI (2#11). R5>'' A6 N'6+' TB-HIV P5759'6'

T;5,+6 2#112#1. J'',' D6,5+,' J595,' P5759'6' P5*'6 9'

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8. D:+:+96;,++? D. R5@6,++76 (R5@6,'+,* M596>65). J'',' E%C 2##.. C,++? J.? H+,5? N.? M65,? F. T;5,+6 K66 29 59. J'',' =69*' M596' 2##2.

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