NeuroAIDS in Indonesia

1
NeuroAIDS in Indonesia

• Darma Imran
• Dept of Neurology University of Indonesia, RSCM
  Hospital,
• Pokdisus AIDS Fakultas Kedokteran Universitas
  Indonesia, Jakarta

NeuroAIDS in Asia Pacific Rim July 19-20,
2007 Sydney, Australia
2
Reported AIDS Cases in Indonesia, 1995-2006
Escalating HIV epidemic in Indonesia
Searo WHO 2007
3
HIV Cases in RSCM Hospital, Jakarta
Pokdisus AIDS FKUI
4
Number of HIV Cases in Neuro-Ward RSCM Hospital,
Jakarta 2003-2006
2003
2004
2005
2006
NeuroAIDS in Asia and the Pacific Rim July
19-20, 2007 Sydney, Australia
5
NeuroAIDS Development

• 2002 2003
• AIDS patients admitted to neuro-ward
• 2003 e-mail correspondence with APNAC member
• 2004
• ASHM
• Algorithm guidelines repeated lumbar puncture
  for CM
• 2005
• APNAC Study
• Pyrimethamine
• NeuroAIDS workshop in Jakarta
• 2006
• Research colaboration with University of Western
  Australia

6
NeuroAIDS Networking

• Jakarta
• 4 hospitals ( each hospital has outpatient case
  load 10-40 per day)
• 9 doctors, 1 neuropsychologist
• Bandung 1 hospital
• Surabaya 1 hospital
• Medan 1 hospital
• Bali 1 hospital
• Padang 1 hospital

7
NeuroAIDS in RSCM Hospital

• AIDS hospital admissions with a neurological
  diagnosis 56
• Overall AIDS-related CNS complication mortality
  rate 44

8
(No Transcript)
9
(No Transcript)
10
Empiric Treatment for AIDS- Related Focal Brain
Lesions

• Empiric Anti-Toxoplasma Therapy
• CD4 lt200 cells/uL
• Multiple ring-enhancing lesions
• No history of co-trimoxazole prophylaxis
• Empiric Anti-Tuberculous Therapy
• CD4 gt 200 cells/uL
• Multiple ring-enhancing lesions
• Chest X-ray consistent with TB
• Empiric Antibiotic therapy for Bacterial Brain
  Abscess
• Neuroimaging study compatible with bacterial
  brain abscess

11
AIDS-related CNS Opportunistic Disease in RSCM
Hospital, Jakarta, Jan 2004 - April 2007 (N317)
Mortality 64
Mortality 50
Mortality 30
Mortality 56
Mortality 45
Mortality 53
12
Factor Associated with Mortality of AIDS-related
CNS Complications
GCS Glasgow Coma Scale
13
Challenges

• Patients admitted with advanced disease
• Mortality rate 44 (AIDS-related CNS
  Opportunistic Disease )
• TB prevalence is high
• ? Lumbar puncture
• ? Laboratory service
• Microbiologic diagnosis
• Viral load testing
• ? Neurosurgical involvement
• ? Pathological and Postmortem confirmation

14
Future plan

• Service
• CMV EBV PCR
• Lumbar drain for CM
• Workshop Basic neurological skills for
  non-neurologist physician
• Research
• CSF proteomic research
• CSF bank
• Identification of drug resistant TB
• Rapid identification of TB meningitis vs
  bacterial meningitis
• HIV dementia and neuropathy prospective study

15
Thank youdarma_imran_at_cbn.net.id