WHO. 2010. Treatment of Tuberculosis : guideline -4th Edition

Hepatitis imbas obat(OAT)

Bila penyakit hati disebabkan OAT semua obat dihentikan

Bila pasien sakit berat dan tidak aman untuk menghentikan pengobatan pertimbangkan untuk memuali regimen non-hepatotoksik straptomisin,

etambutol dan fluoroquinolone

Bila pengobatan TB sudah dihentikan, tunggu hingga fungsi normal kemudian coba OAT (sebaiknya tunggu 2 minggu setelah resolusi sebelum memulai)

Bila tanda & gejala tidak membaik dan penyakit hati berat regimen non-hepatotoksik dimulai atau dilanjutkan selama 18-24 bulan

WHO. 2010. Treatment of Tuberculosis : guideline -4th Edition

Hepatitis imbas obat(OAT)

Bila sudah sembuh dari hepatitis imbas obat, mulai pemberian obat

Bila timbul gejala atau tes fungsi hati abnormal, obat yang

terakhir diberikan dihentikan

Pada pasien dengan riwayat ikterus dianjurkan untuk menghindari

Pyrazinamid

Disarankan untuk memulai dari rifampisin. Dilanjutkan dengan

isoniazid setelah 3-7 hari

Bila tidak dapat diberikan isoniazid ataupun rifampisin, regimen non-hepatotoksik diberikan selama 18-

24 bulan

WHO. 2010. Treatment of Tuberculosis : guideline -4th Edition.

E Jong, F Conradie, R Berhanu, dkk. September 2013. S Afr J HIV Med: Guideline consensus statement: management of drug-induced liver injury in HIV-positive patients treated for TB. p. 116

E Jong, F Conradie, R Berhanu, dkk. September 2013. S Afr J HIV Med: Guideline consensus statement: management of drug-induced liver injury in HIV-positive patients treated for TB. p. 116

WHO. 2010. Treatment of Tuberculosis : guideline -4th Edition. p.85

WHO. June 2013. Consolidated guidelines on the use of anti retroviral drugs for treating and preventing HIV infection recommendations for a public health approach, p.91

Clinical Stage 3• Unexplained severe weight loss (over 10% of presumed or measured body

weight)• Unexplained chronic diarrhoea for longer than 1 month• Unexplained persistent fever (intermittent or constant for longer than 1 month)• Persistent oral candidiasis• Oral hairy leukoplakia• Pulmonary tuberculosis• Severe bacterial infections (e.g. pneumonia, empyema, meningitis, pyomyositis,

bone or joint infection, bacteraemia, severe pelvic inflammatory disease)• Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis• Unexplained anaemia (below 8 g/dl ), neutropenia (below 0.5 x 109/l) and/or

chronic• thrombocytopenia (below 50 x 109/l)

WHO. 2010. Antiretroviral therapy for HIV infection in adults and adolescents Recommendations for a public health approach 2010 revision. p. 27

Clinical stage 4• HIV wasting syndrome• Pneumocystis jiroveci pneumonia• Recurrent severe bacterial pneumonia• Chronic herpes simplex infection (orolabial, genital or anorectal of more than 1 month’s• duration or visceral at any site)• Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)• Extrapulmonary tuberculosis• Kaposi sarcoma• Cytomegalovirus disease (retinitis or infection of other organs, excluding liver, spleen and• lymph nodes)• Central nervous system toxoplasmosis• HIV encephalopathy• Extrapulmonary cryptococcosis including meningitis• Disseminated nontuberculous mycobacteria infection• Progressive multifocal leukoencephalopathy• Chronic cryptosporidiosis• Chronic isosporiasis• Disseminated mycosis (histoplasmosis, coccidiomycosis)• Recurrent septicaemia (including nontyphoidal Salmonella)• Lymphoma (cerebral or B cell non-Hodgkin)• Invasive cervical carcinoma• Atypical disseminated leishmaniasis• Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy

WHO. 2010. Antiretroviral therapy for HIV infection in adults and adolescents Recommendations for a public health approach 2010 revision. p. 28

WHO. 2010. Antiretroviral therapy for HIV infection in adults and adolescents Recommendations for a public health approach 2010 revision. p. 28