Background: Increasing age of HIV-1 infected population brought about the risk of frailty as comorbidity, whose prevalence is higher in low and middle-income countries (LMICs). Indonesia as an LMIC also bears a major burden of HIV-1 epidemic with a similarly aging population, but the prevalence of frailty and its predictors are unknown. Objectives: To identify the prevalence of frailty and analyze its associated factors, among HIV-1 infected adults under antiretroviral therapy in Indonesia. Methods: A cross-sectional study was conducted among HIV-infected individuals with inclusion criteria of age ≥30 years old and underwent ART for at least 6 months. The main assessment was done using Fried’s frailty phenotype score, which categorizes subjects into non-frail, pre-frail, or frail. Factors associated with frailty were characterized and multiple logistic regression analysis was performed. Results: A total of 164 subjects were recruited; male subjects were 118 (72%), the median age was 40.5 years old, and the median CD4 nadir was 53 cells/μl. Frailty was identified among 90 (54.9%) subjects with 84 (51.2%) identified as pre-frail and 6 (3.7%) as frail, with dominant frailty phenotype was weakness in grip strength. The multivariate model showed that depression was the only factor significantly correlated with pre-frailty and frailty (OR 2.14; 95% CI 1.04-4.43, p=0.036). Conclusion: Frailty is a common occurrence among HIV-infected patients under ART, with depression as an independent predictive factor.

ABSTRAKPendahuluan. Infeksi masih merupakan ancaman yang serius bagi dunia kesehatan saat ini, terutama bagi populasi khusus seperti usia lanjut. Usia dinyatakan sebagai salah satu faktor prediktor dalam keberhasilan vaksinasi. Semakin tua usia seseorang, respon imunnya akan semakin buruk. Respon yang berbeda pada usia lanjut ini diperkirakan karena frailty dan kejadian immunosenescense yang mendasarinya. Penelitian ini dilakukan untuk mengetahui hubungan status frailty dengan respon imun pascavaksinasi influenza pada populasi usia lanjut.Metode. Studi kohort retrospektif ini mengambil data dari penelitian induk dengan subjek usia lanjut berusia ≥60 yang tergabung dalam Posyandu Lansia di 4 kelurahan di Kecamatan Pulo Gadung, Jakarta Timur. Status frailty ditentukan berdasarkan kuisoner Frailty Index 40 Items (FI-40). Vaksin Influenza yang dievaluasi adalah vaksin influenza trivalen inaktif. Serokonversi didefinisikan sebagai peningkatan titer inhibisi hemagglutinin sebanyak 4x lipat. Seroproteksi didefinisikan sebagai titer inhibisi hemagglutinin ≥1:40.Hasil. Terdapat 140 subjek penelitian. Tingkat serokonversi vaksin influenza pada kelompok frail, pre-frail dan sehat adalah 37,9%, 39% dan 60%. Tingkat seroproteksi vaksin influenza pada kelompok frail, pre-frail dan sehat adalah 80%, 92,2% dan 94,8% . Risiko relatif (RR) kelompok pre-frail/frail untuk kejadian tidak serokonversi adalah 0,93 (IK 95% 0,72-1,02) dan RR untuk kejadian tidak seroproteksi adalah 1,7 ( IK 95% 0,5-6,2).Simpulan. Tidak ditemukan hubungan antara status frailty dengan serokonversi dan seroproteksi vaksin influenza pada populasi usia lanjut. Frailty, pre-frail, frail, serokonversi, seroproteksi, usia lanjut, vaksin Kata Kunci:

Purpose Fall is one of the geriatric syndromes and a significant public health concern, which causes potentially severe consequences among the elderly. Geriatric syndromes are common among PLHIV and affect younger age than the general population. This study attempted to identify the risk of falls in PLHIV on antiretroviral therapy (ART) and its related factors among older adults with HIV infection. Methods This cross-sectional study was conducted from December 2019 to May 2020 among PLHIV aged ≥40 years who received ART for at least 6 months in HIV Integrated Clinic, Cipto Mangunkusumo Hospital, Jakarta. Bivariate and multivariate analyses were performed using Poisson regression with robust estimator using STATA version 12.0. Results A total of 102 participants mainly consisted of males (83.3%) with a median age of 45 (IQR 5) years. The risk of fall was detected in 52% of these participants. PLHIV who have history of falls, current CD4 below 200 cells/mm 3 , and pre-frail–frail status were associated with an increased risk of falls in the future. An LPV/r-based regimen was found to be a protective factors of risk of falls among PLHIV. Conclusion History of falls, current CD4 below 200 cells/mm 3 , and pre-frail and frail status were identified as factors associated with a greater risk of fall among PLHIV.

ABSTRAKPendahuluan. Vaksin influenza sebagai satu-satunya modalitas pencegahan infeksi virus influenza yang ada saat ini memiliki efikasi yang lebih rendah pada lansia dibanding dewasa muda. Hal ini dimungkinkan karena pada lansia terjadi perubahan respon imun akibat penuaan serta faktor-faktor risiko lain. Penelitian ini dilakukan untuk mengidentifikasi faktorfaktor prediktor serokonversi pasca-vaksinasi influenza pada lansia.Metode. Studi kohort retrospektif pada populasi lansia di posyandu lansia Jakarta Timur yang mendapatkan vaksin influenza. Sebanyak 277 subjek diperiksa titer antibodi pra dan satu bulan pasca-vaksinasi influenza. Faktor-faktor risiko berupa usia, jenis kelamin, status olahraga, status merokok, penyakit DM tipe 2, paru, kardiovaskular, status nutrisi MNA (Mini Nutritional Assessment), status GDS (Geriatric Depression Scale), dan titer antibodi pra-vaksinasi dinilai pada masing-masing subjek.Hasil. Proporsi lansia yang mengalami serokonversi (kenaikan titer pasca-vaksinasi sebanyak 4 kali lipat titer awal) adalah 50,9% (141/277). Pada analisis multivariat, faktor-faktor prediktor serokonversi satu bulan pasca-vaksinasi influenza pada lansia di komunitas adalah keadaan tidak depresi (p=0,048, OR=2,1, IK=1,01-4,30), status olahraga ≥ 5 kali seminggu minimal 30 menit (p=0,013,OR 4,0, IK 1,76), dan titer antibodi pra-vaksinasi yang tidak seroprotektif (p=0,000, OR 6,4, IK 3,40-11,99).Simpulan. Faktor-faktor prediktor serokonversi pasca-vaksinasi influenza pada lansia di komunitas adalah status depresi, status olahraga, dan titer antibodi pra-vaksinasi influenza.Kata Kunci: faktor prediktor, influenza, serokonversi, vaksinasi ABSTRACT Introduction. The influenza vaccine as the most effective method for preventing influenza virus infection currently has lower efficacy in the elderly than younger adults due to change of immune response as well as other risk factors. This study aims to identify predictor factors affecting seroconversion post-influenza vaccination in elderly.

BACKGROUND Kidney function profile is one of the important parameters in determining the health of the elderly. In Indonesia, no study has been conducted on kidney function profile during Ramadan fasting to determine the safety of Ramadan fasting in the elderly. This study aimed to determine the kidney function profile in the elderly who fasted during Ramadan. METHODS This study used a prospective cohort design. The inclusion criteria were elderly aged >60 years undergoing Ramadan fasting in Jatinegara, Jakarta from April to July 2019. Patients with end-stage renal failure who had an acute infection, hypertension crisis, or refused to participate in the study were excluded. Patients who did not fast for 3 consecutive days were dropped out. The kidney function profile was calculated by the estimated glomerular filtration rate (eGFR) using the CKD-EPI formula 1 week before the first day of Ramadan, 3 weeks after the first day of fasting, and 2 weeks after the last day of fasting. Decreased eGFR was defined as having a minimum of 20% eGFR decline during or after the fasting period. Bivariate analysis was performed using McNemar or Cochran tests. RESULTS 2 patients had eGFR decline during fasting, and 7 patients had eGFR decline after fasting. The median eGFR before, during, and after fasting were 81.5, 88.7, and 76.8 ml/min/1.73 m², respectively. A total of 1.4% of subjects had decreased eGFR during Ramadan, while 9.1% had decreased eGFR after Ramadan. However, the changes were not statistically significant. CONCLUSIONS Although most elderly had lower eGFR following Ramadan fasting compared to before and during Ramadan, only individuals with several comorbidities had significant changes of kidney function.