Correlation between CD4 cell counts with mucocutaneous manifestations: study of HIV patients in Dr. Sardjito General Hospital, Yogyakarta

https://doi.org/10.19106/JMedSci005001201805

Satiti Retno Pudjiati(1*), Nadia Akita Dewi(2), Sekar Sari Arum Palupi(3)

(1) Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta
(2) Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta
(3) Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta
(*) Corresponding Author

Abstract


Mucocutaneous disorders often seen in HIV patients with varying morbidity. The HIV
progression is characterized by the declining of CD4 cell counts and emergence of
mucocutaneous manifestations. The aim of the study was to evaluate the relationship
between CD4 cell counts with mucocutaneous manifestations in HIV patients. This was
a cross-sectional study based on medical records at Dr. Sardjito General Hospital during
the period January 2011-December 2015. Data of patient’s age, sex, risk factors of
transmission, most mucocutaneous manifestations and CD4 cell count were gathered. The
correlation between CD4 cell counts with muscocutaneous manifestations were analyzed
using chi-square test. A total 928 patients were involved in the study. More than half of
the patients were male (65.4%) and mostly, the patients aged 20-29 years (38.69%).
The main risk factors for HIV transmission were unsafe sex (75%). The highest CD4 cell
counts was 1094 cells/mm3 and the lowest was 1 cell/mm3. We found 306 cases of
mucocutaneous manifestations. The most mucocutaneous manifestations was a fungal
infection (40.4%) with the highest infection type was oral candidiasis(33.8%); then noninfection
(28%) with the highest type was drug eruption(35.9%); and tumors(0.5%) that
was only Kaposi sarcoma cases. We also found sexually transmitted infections (STIs)
(18.85%) with the highest cases was condyloma acuminata (49.3%). Statistical analysis
showed a significantly relationship between CD4 cell counts with a fungal infection
(p <0.0001; OR= 3.8; 95% CI: 2.29 - 6.30), viral infection (p =0.0031; OR= 0.4;
95% CI: 0.24-0.74) and parasitic infection (p=0.043; OR= 0.2; 95% CI: 0.06-0.61).
In conclusion, alteration in CD4 cell counts affects opportunistic infections occurence
in HIV patients. Lower CD4 cell counts (<200 cells/mm3) increases the risk of fungal
infection as much as 3.8 times. Higher CD4 cell counts (>200 cells/mm3) increases the
risk of viral infection by about 2.5 times and parasitic infections as much as 5 times.


Keywords


CD4 cell count; mucocutaneous manifestations; HIV; opportunistic infection; fungal infection

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References

  1. World Health Organization. Global health observatory data: HIV/AIDS. [serial online]. 2016 [cited 2016 March 28]. Available from: http://www.who.int/gho/hiv/en/
  2. The Joint United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS Update 2017[serial online]. 2017 [cited 2017 August 28]. Available from : http://aidsinfo.unaids.org/
  3. Ministry of Health, Republic of Indonesia. Statistik kasus HIV/AIDS di Indonesia. [serial onoline]. 2016. [cited 2016 March 23]. Available from: http://spiritia.or.id/Stats/StatCurr.pdf
  4. Ministry of Health, Republic of Indonesia. Situasi dan analisis HIV AIDS. [serial online]. 2014 [cited 2016 March 23]. Available from:hhttp://www.depkes.go.id/resources/download/pusdatin/infodatin/Infodatin%20AIDS.pdf
  5. Aydin ÖA, Karaosmanoğlu KH, Korkusuz R, Özeren M, Özcan N. Mucocutaneous manifestation and the relationship to CD4 lymphocyte counts among Turkish HIV/AIDS patients in Istanbul, Turkey. Turk J Med Sci 2015; 45(1):89-92. http://dx.doi.org/10.3906/sag-1308-3
  6. Singh H, Singh P, Tiwari P, Dey V, Dulhani N, Singh A. Dermatological manifestation in HIV-Infested patients at a tertiary care hospital in a tribal (Bastar) region of Chhattisgarh, India. Indian J Dermatol 2009; 54(4):338-41. http://dx.doi.org/10.4103/0019-5154.57609
  7. Oninla OA. Mucocutaneous manifestations of HIV and the correlation with WHO clinical staging in a tertiary hospital in Nigeria. AIDS Res Treat 2014; 2014:360970. http://dx.doi.org/10.1155/2014/360970.
  8. Vijaya Kumari A, Penchalaiah K, Sreenivasulu Naik R. Mucocutaneous manifestations in HIV patients. Int J Sci Res 2016; 5:240-2.
  9. Avert. Men who have sex withmen (MSM) and HIV AIDS. [serial online]. 2016 [cited 2016 March 25]. Available from: http://www.avert.org/professionals/hiv-social-issues/key-affected-populations/men-sex-men#footnote9_8wpg3qu.
  10. Mboi N, Smith KH. Current status of HIV/AIDS in Indonesia and prospect for its spread. In: Yamamoto T, Itoh S. editor. ‘Indonesia,’ fighting a rising tide: the response to AIDS in East Asia. Tokyo: Japan center for international exchange, 2006: 96118.
  11. Amerson EH, Maurer TA. Dermatologic manifestation of HIV in Africa. Top HIV Med 2010; 18(1):16-22.
  12. Febriani. Pola penyakit saraf pada penderita HIV AIDS di RSUP Dr. Kariadi Semarang. [internet]. 2010. [cited 2016 March 28]. Available from: http://eprints.undip.ac.id/23633/1/Nurul_F.pdf.
  13. Sharma SK, Soneja M. HIV and immune reconstitution inflammatory syndrome (IRIS). Indian J Med Res 2010; 134(6):866-77. http://dx.doi.org/10.4103/0971-5916.92632
  14. da Silva BC, Paula CR, Auler ME, Ruiz Lda S, Dos Santos JI, Yoshioka MC, et al. Dermatophytosis and immunovirological status of HIV infected and AIDS patients from Sao Paulo city Brazil. Mycoses 2014; 57(6):371-6. http://dx.doi.org/10.1111/myc.12169
  15. Cohen MS. Sexually transmitted disease enhance HIV transmission: no longer a hypothesis. Lancet 1998; 351(suppl III):5-7. http://dx.doi.org/10.1016/S0140-6736(98)90002-2
  16. Singrodia S, Panchal M, Solanki RB, Rawal RC. Resistant condyloma acuminata in HIV positive patient treated with cryotherapy once a week along with alternate day application of topical imiquimod 5% cream. Indian J Sex Transm Dis 2008; 29(1):49-50.http://dx.doi.org/10.4103/0253-7184.42721
  17. Robert H. Lurie Comprehensive Cancer Center of Northwestern. Types of Cancer: AIDS/HIV related malignancies. [serial online]. 2016 [cited 2016 February 20th]. Available from:http://cancer.northwestern.edu/cancertypes/ cancer_type.cfm?category=1#
  18. Robert H. Lurie Comprehensive Cancer Center of Northwestern. HIV and AIDS related cancer:introduction. [serial online]. 2016 [cited March 23th]. Available from: http://cancer.northwestern.edu/cancertypes/cancer_type.cfm?category=1#



DOI: https://doi.org/10.19106/JMedSci005001201805

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