Terapi Doxycycline pada Laki-laki Homoseksual dengan Sifilis Sekunder dan Infeksi Human Immunodeficiency Virus
DOI:
https://doi.org/10.56951/medicinus.v34i1.52Kata Kunci:
doxycycline, HIV, homoseksual, sifilis sekunderAbstrak
Pendahuluan: Re-emergence sifilis banyak ditemukan pada laki-laki homoseksual dengan infeksi HIV positif. Perjalanan penyakit sifilis pada pasien dengan HIV lebih cepat dan berisiko tinggi menjadi neurosifilis. Koinfeksi sifilis dan human immunodeficiency virus (HIV) dikaitkan dengan penurunan CD4 dan peningkatan HIV-RNA. Perbaikan keduanya dikaitkan dengan terapi sifilis yang efektif, salah satunya dengan terapi doxycycline. Doxycycline memiliki efek antiinflamasi yang berhubungan dengan penurunan viral load serta peningkatan CD4 pada pasien positif HIV. Kasus: Laki-laki warga negara asing berusia 20 tahun dengan keluhan utama bintik merah tidak gatal pada sekujur tubuh yang muncul selama 2 hari disertai demam. Pasien sudah berobat namun belum tampak perbaikan. Riwayat berhubungan seksual sesama jenis dan bergonta-ganti pasangan lebih dari 10 kali dalam 10 tahun terakhir, serta jarang menggunakan kondom. Regio generalisata tampak papul eritem multipel diskret berukuran miliar hingga lentikular. Regio skrotum dan penis pasien terdapat lesi makula eritema, plak indurasi sewarna kulit multipel berbatas tegas. Teraba pembesaran kelenjar getah bening regio inguinalis. Pemeriksaan VDRL 1:32 dan TPHA 1:640. Hasil pemeriksaan HIV reaktif 241,50 dengan nilai CD4 558 sel/ml. Pasien diedukasi untuk menjalani abstinensi hubungan seksual. Terapi yang diberikan adalah doxycycline 2x100 mg selama 14 hari, serta ARV nevirapine, lamivudine, dan zidovudine. Pasien mengalami perbaikan manifestasi klinis dalam sebulan pengobatan. Pemeriksaan VDRL saat kontrol bulan ketiga adalah 1:2 dengan CD4 570 sel/ml. Pembahasan: Doxycycline merupakan lini kedua untuk tata laksana penyakit sifilis yang berdasarkan studi mampu membantu menurunkan viral load dan meningkatkan jumlah CD4 pada penderita sifilis dengan HIV. Pada kasus ini, penurunan titer VDRL pasien secara signifikan dibanding titer awal mengindikasikan keberhasilan terapi. Hasil pemeriksaan CD4 pasien juga mengalami kenaikan pada bulan ketiga.
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