Drug-Related Problems (DRPs) in Patients with HIV and Tuberculosis Co-infection at a Referral Hospital in Central Java, Indonesia / Kejadian Drug-Related Problems (DRPs) Pada Pasien HIV dengan koinfeksi Tuberkulosis di Rumah Sakit Rujukan Jawa Tengah, Indonesia

Introduction: Tuberculosis and human immunodeficiency virus (TB-HIV) co-infection necessitates complex combination therapy using antituberculosis drugs (ATD) and antiretroviral therapy (ARV), significantly increasing the risk of drug-related problems (DRPs). However, data on DRPs patterns among TB-HIV patients in Indonesian referral hospitals remain limited. Objective: This study aimed to identify and describe the types and prevalence of DRPs among TB-HIV outpatients at a referral hospital in Central Java, Indonesia. Methods: A descriptive observational study with a retrospective approach was conducted using medical records of TB-HIV outpatients from January 2024 to December 2025. A total of 111 patients meeting the inclusion criteria were selected using total sampling. DRPs were identified based on Cipolle's classification, covering indication, effectiveness, safety, and adherence-related problems. Results: Most patients were male (66.7%), adults (71.2%), received the HRZE regimen (91.0%), received TDF+3TC+EFV antiretroviral therapy (53.2%), and were in the intensive phase of tuberculosis treatment (91.0%). The majority experienced ≥3 DRPs (64.9%), with a mean of 2.98 DRPs per patient. The most prevalent DRPs were drug interactions reducing drug concentration or therapeutic effects (97.3%), followed by drug interactions increasing drug concentration or toxicity (62.2%), need for additional drug therapy (37.8%), and medication non-adherence (34.2%). Conclusion: DRPs were highly prevalent among TB-HIV patients, predominantly involving drug interactions that may reduce treatment effectiveness or increase toxicity. Routine therapeutic monitoring and clinical pharmacist-led medication reviews are essential to optimize treatment outcomes in TB-HIV patients.

Pendahuluan: Koinfeksi tuberkulosis dan human immunodeficiency virus (TB-HIV) memerlukan kombinasi terapi antituberkulosis (OAT) dan antiretroviral (ARV) yang kompleks, sehingga meningkatkan risiko drug-related problems (DRPs). Namun, data mengenai pola DRPs pada pasien TB-HIV di rumah sakit rujukan Indonesia masih terbatas.Tujuan: Penelitian ini bertujuan mengidentifikasi dan menggambarkan jenis serta prevalensi DRPs pada pasien TB-HIV rawat jalan di rumah sakit rujukan Jawa Tengah, Indonesia. Metode: Studi observasional deskriptif dengan pendekatan retrospektif dilakukan menggunakan rekam medis pasien TB-HIV rawat jalan periode Januari 2024–Desember 2025. Sebanyak 111 pasien yang memenuhi kriteria inklusi dipilih menggunakan total sampling. Identifikasi DRPs berdasarkan klasifikasi Cipolle mencakup aspek indikasi, efektivitas, keamanan, dan kepatuhan. Hasil: Mayoritas pasien berjenis kelamin laki-laki (66,7%), usia dewasa (71,2%), menggunakan regimen OAT HRZE (91,0%), regimen ARV TDF+3TC+EFV (53,2%), serta berada pada fase intensif pengobatan TB (91,0%). Sebagian besar pasien mengalami ≥3 DRPs (64,9%) dengan rata-rata 2,98 DRPs per pasien. DRPs paling umum adalah interaksi obat yang menurunkan kadar atau efek obat (97,3%), diikuti interaksi obat yang meningkatkan kadar atau efek toksik (62,2%), kebutuhan terapi tambahan (37,8%), dan ketidakpatuhan pengobatan (34,2%). Kesimpulan: Kejadian DRPs pada pasien TB-HIV masih tinggi dengan dominasi interaksi obat yang berpotensi menurunkan efektivitas maupun meningkatkan toksisitas terapi. Pemantauan terapi rutin dan medication review oleh apoteker klinis sangat diperlukan untuk mengoptimalkan luaran pengobatan pasien TB-HIV.