On Friday, January 10, 2025, the Faculty of Public Health (FPH) of the Universitas Indonesia (UI) held the Doctoral Promotion session in Epidemiology for Promovendus Rizky Fajar Meirawan, with Prof. dr. Mondastri Korib Sudaryo, M.S., D.Sc., serving as the Chair of the session. Rizky Fajar Meirawan defended his dissertation titled “Risk Factors and Prediction Model for Seropositive Immunoglobulin-G Toxoplasma Gondii in Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome Patients.”
In his dissertation, Rizky Fajar explained the relationship between oral sex behavior and consumption of grilled ruminant meat with seropositive Immunoglobulin-G (IgG) for Toxoplasma gondii in Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) patients. Seropositive IgG indicates chronic Toxoplasma gondii infection in HIV patients. Toxoplasma gondii infection can lead to death and dangerous nervous system diseases, such as meningitis (inflammation of the brain membranes) or encephalitis (brain inflammation). However, the clinical symptoms of Toxoplasma gondii infection do not appear when the immune condition of the HIV patient is sufficiently good, especially when the CD4 count is still above 200 cells per mm3.
Meningitis and encephalitis are two dangerous diseases resulting from Toxoplasma gondii infection. These two diseases arise due to a weakened immune system, one of which is caused by a drop in the CD4 count to below 200 cells per mm3. One action that can be taken to prevent these two diseases is to perform serological tests for Toxoplasma gondii and take steps to treat the infection if the serology test is positive.
In his dissertation, Rizky Fajar explained that a positive serological status for Toxoplasma gondii can be predicted through the measurement of oral sex behavior and the consumption of grilled ruminant meat. Oral sex is defined as the oral sexual behavior of HIV patients with partners who do not use condoms and engage in swallowing ejaculate fluid from their partners. Oral sex behavior is associated with infection due to the potential ingestion of Toxoplasma gondii found in ejaculate fluid.
Ruminants are a group of livestock animals with a complex stomach, such as cattle, goats, sheep, and buffalo. Ruminant livestock can be infected with Toxoplasma gondii because they consume grass and forage contaminated with Toxoplasma gondii oocysts. The source of the contamination is cat feces that contain Toxoplasma gondii oocysts. In the meat of infected ruminant animals, Toxoplasma gondii cysts are present.
Consuming grilled ruminant meat (such as satay, grilled meat, or steak) allows the Toxoplasma gondii cysts in the meat to remain intact. Therefore, when HIV/AIDS patients consume this meat, they can become infected with Toxoplasma gondii. Thus, Toxoplasma gondii is classified as a foodborne disease.
Rizky Fajar recommended that oral sex behavior and grilled ruminant meat consumption be examined along with HIV testing. In his dissertation, Rizky Fajar designed a questionnaire to measure these two behaviors in HIV patients. HIV patients who engage in oral sex and/or consume grilled ruminant meat should be referred for serological testing for Toxoplasma gondii, even if the patient does not show clinical symptoms. This aims to detect the disease in its early stages, allowing for earlier treatment. The hope is that this early detection will improve the life expectancy of HIV patients by treating Toxoplasma gondii infections sooner.
In his dissertation, Rizky Fajar recommended that the Ministry of Health and all parties involved in HIV control programs in Indonesia promote healthy sexual behaviors, especially oral sex. The use of condoms during oral sex and thoroughly cooking ruminant meat are two steps that can reduce the risk of Toxoplasma gondii infection in HIV patients.
In preparing his dissertation, Rizky Fajar was guided by Prof. Dr. dr. Sudarto Ronoatmodjo, S.K.M., M.Sc., as the Promotor, and Dr. dr. Tri Yunis Miko Wahyono, M.Sc., and Prof. dr. Agnes Kurniawan, Ph.D., Sp.Par.K. (K) as Co-promotors. Rizky Fajar successfully defended his dissertation, overcoming objections from the examining team, which was led by Prof. Dr. R. Budi Haryanto, S.K.M., M.Kes., M.Sc., with the other examiners including Prof. Dr. dr. Evy Yunihastuti, Sp.PD, K-AI, FINASIM; Prof. Dr. drh. Hj. Umi Cahyaningsih, M.S.; Prof. Dr. Ede Surya Darmawan, S.K.M., M.D.M.; and Prof. Dr. Besral, S.K.M., M.Sc. As a result of his success, Rizky Fajar Meirawan was awarded a Doctorate in Epidemiology from the University of Indonesia. (prom)