<![CDATA[Human Immunodeficiency Virus (HIV) merupakan virus yang menyerang sistem kekebalan tubuh manusia, terutama sel CD4 (T helper) sehingga menyebabkan penurunan fungsi imun dan meningkatkan risiko infeksi oportunistik. Seorang laki-laki berusia 31 tahun dengan HIV dan tuberkulosis paru datang dengan keluhan batuk sejak ±1 bulan yang memberat, disertai dahak bercampur darah, demam hilang timbul, keringat malam, penurunan berat badan, serta sesak napas ringan. Pasien memiliki riwayat TB paru dan sedang menjalani Obat Anti Tuberkulosis (OAT) selama ±5 bulan namun belum membaik, serta riwayat HIV sejak ±2 tahun dengan ketidakpatuhan terapi Antiretroviral (ARV). Pemeriksaan fisik menunjukkan kondisi sakit sedang dengan ronki pada kedua lapang paru, hasil HIV reaktif, dan radiologi mendukung TB paru. Tatalaksana meliputi OAT fase lanjutan (rifampisin 600 mg/hari dan isoniazid 300 mg/hari), pemberian ARV (tenofovir 300 mg, lamivudine 300 mg, efavirenz 600 mg sekali sehari), kotrimoksazol 960 mg/hari, serta terapi suportif dan edukasi kepatuhan pengobatan. Koinfeksi HIV dan tuberkulosis memiliki hubungan yang saling memperburuk, di mana HIV mempercepat progresivitas TB sedangkan TB meningkatkan replikasi virus HIV. Pada kasus ini, ketidakpatuhan terapi ARV menyebabkan imunosupresi sehingga TB paru sulit dikendalikan dan meningkatkan risiko kegagalan terapi serta resistensi obat. Oleh karena itu, penatalaksanaan yang optimal melalui terapi OAT dan ARV yang teratur disertai kepatuhan dan pemantauan yang baik sangat penting untuk memperbaiki prognosis pasien. ABSTRACT Human Immunodeficiency Virus (HIV) is a virus that attacks the human immune system, particularly CD4 (T helper) cells, leading to a decline in immune function and an increased risk of opportunistic infections. A 31-year-old man with HIV and pulmonary tuberculosis presented with a cough that had persisted for approximately one month and progressively worsened, accompanied by blood-streaked sputum, intermittent fever, night sweats, weight loss, and mild dyspnoea. The patient had a history of pulmonary TB and had been undergoing Anti-Tuberculosis Treatment (ATT) for around five months without improvement, as well as a history of HIV for about two years with poor adherence to Antiretroviral (ARV) therapy. Physical examination revealed a moderately ill patient with rhonchi in both lung fields, a reactive HIV result, and radiology supporting pulmonary TB. Management included the continuation phase of ATT (rifampicin 600 mg/day and isoniazid 300 mg/day), ARV therapy (tenofovir 300 mg, lamivudine 300 mg, and efavirenz 600 mg once daily), cotrimoxazole 960 mg/day, as well as supportive therapy and education on treatment adherence. The coinfection of HIV and tuberculosis has a mutually aggravating relationship, in which HIV accelerates the progression of TB while TB increases HIV viral replication. In this case, non-adherence to ARV therapy caused immunosuppression so that pulmonary TB became difficult to control and increased the risk of treatment failure and drug resistance. Therefore, optimal management through regular ATT and ARV therapy accompanied by good adherence and monitoring is essential to improve the patient’s prognosis.]]>
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