Hubungan Status Imunologis dengan Stadium Klinis pada Pasien Human Immunodeficiency Virus (HIV)
DOI:
https://doi.org/10.35790/msj.v7i1.55502Abstract
Abstract: Human Immunodeficiency Virus (HIV) infection is still quite common in Indonesia. The clinical stage of HIV determines HIV prognosis. Opportunistic infections are one of the criteria for assessing the clinical stage of HIV. Level of CD4 influence the incidence of opportunistic infections. This study aimed to analyze the relationship between immunological status and HIV clinical stage. This was an descriptive and analytical study with a cross-sectional design using 73 medical records of HIV patients who sought treatment at one of the hospitals in Jakarta between January 2022 and May 2023. Data on sex, body mass index, CD4 levels, clinical stage, and opportunistic infections were collected from medical records. The sample selection technique was consecutive non-random sampling. HIV patients that received antiretroviral therapy (ARV) were included in this study. The chi-square test was used for analysis with a significance level of 5%. The results showed that the majority subjects were male (63.0%), underweight (49.3%), CD4 <200 cells/mm3 (46.6%), had opportunistic infection of pulmonary TB (23.3%), and clinical stage III (45.2%). The chi-square test obtained a p-value of <0.001 for the relation between CD4 level and clinical stage of HIV. In conclusion, immunological status based on CD4 levels can be one of the factors used to assess the severity of HIV disease clinically in patients receiving ARV therapy.
Keywords: human immunodeficiency virus; CD4; clinical stage; opportunistic infection
Abstrak: Infeksi Human Immunodeficiency Virus (HIV) masih cukup banyak ditemukan di Indonesia. Prognosis HIV dipengaruhi oleh stadium klinis HIV. Infeksi oportunistik dinilai dalam penentuan stadium klinis HIV. Kejadian dan jenis infeksi oportunistik tergantung pada kadar CD4. Penelitian ini bertujuan menganalisis hubungan status imunologis dengan stadium klinis pada pasien HIV. Jenis penelitian ialah deskriptif analitik dengan desain potong lintang dengan menggunakan 73 rekam medis pasien HIV yang berobat di salah satu RSUD di Jakarta antara Januari 2022 - Mei 2023. Data berupa jenis kelamin, indeks masa tubuh, kadar CD4, stadium klinis dan jenis infeksi oportunistik dikumpulkan dari rekam medis. Tehnik pemilihan sampel adalah consecutive non-random sampling. Penelitian ini hanya mengikutsertakan rekam medis dari pasien yang mendapatkan terapi antiretroviral (ARV). Analisis statistik menggunakan uji chi-square dengan tingkat kemaknaan 0,05. Hasil penelitian mendapatkan mayoritas pasien HIV berjenis kelamin laki-laki (63,0%), memiliki IMT underweight (49,3%), CD4 <200 sel/mm3 (46,6%), infeksi oportunistik TB Paru (23,3%), dan berada pada stadium klinis III (45,2%). Analisis hubungan antara kadar CD4 dengan stadium klinis HIV memperoleh nilai p<0,001. Simpulan penelitian ini ialah status imunologis yang diukur berdasarkan kadar CD4 dapat menjadi salah satu faktor yang digunakan untuk menilai derajat beratnya penyakit HIV secara klinis pada pasien yang menerima terapi ARV.
Kata kunci: human immunodeficiency virus; CD4; stadium klinis; infeksi oportunistik
References
World Health Organization WHO. The global health observatory: explore a world of health data. 2023 [cited 2023 Oct 13]. HIV. Available from: https://www.who.int/data/gho/data/themes/hiv-aids
Aurelina R. Faktor-faktor yang berhubungan terhadap kadar cluster of differentiation 4 (CD4) pada pasien HIV/AIDS. Jurnal Medika Hutama. 2020;2(1Oktober):308–13. Available from: https://jurnalmedika hutama.com/index.php/JMH/article/view/96
Vijayan KKV, Karthigeyan KP, Tripathi SP, Hanna LE. Pathophysiology of CD4+ T-Cell depletion in HIV-1 and HIV-2 infections. Front Immunol. 2017;8:580. Doi: 10.3389/fimmu.2017.00580
Balasubramaniam M, Pandhare J, Dash C. Immune control of HIV. J Life Sci (Westlake Village). 2019;1(1):4–37. Available from: https://pubmed.ncbi.nlm.nih.gov/31468033/
Weinberg JL, Kovarik CL. The WHO clinical staging system for HIV/AIDS. AMA Journal of Ethics. 201;12(3):202–6. Doi: 10.1001/virtualmentor.2010.12.3.cprl1-1003
Aregay AD, Kidane KM, Aregay AB, Fenta KA, Woldegebriel AG, Godefay H, et al. Prediction of CD4 T-lymphocyte count using WHO clinical staging among ART-naïve HIV-infected adolescents and adults in Northern Ethiopia: a retrospective study. AIDS Res Treat. 2020;2020:2163486. Doi: 10.1155/2020/2163486
Edathodu J, Ali B, Alrajhi AA. CD4 validation for the World Health Organization classification and clinical staging of HIV/AIDS in a developing country. Int J Infect Dis. 2009;13(2):243–6. Doi: 10.1016/ j.ijid.2007.12.017
Ebonyi AO, Agbaji OO, Aneje-Okopi JA, Oguche S, Agaba PA, Sagay SA, et al. Factors associated with a low CD4 count among HIV-1 infected patients at enrolment into HAART in Jos, Nigeria. BJMMR. 2014;4(13):2536–45. Doi: 10.9734/BJMMR/2014/8469
Desliana D, Purbaningsih W, Islami U. Cluster of differentiation 4 (CD4) dapat mencegah peningkatan stadium klinis pasien HIV/AIDS: kajian pustaka. Bandung Conference Series: Medical Science. 2022;2(1):487-94. Available from: ttps://doi.org/10.29313/bcsms.v2i1.1020
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach [Internet]. 2nd ed. Geneva: World Health Organization; 2016 [cited 2024 Feb 28]. 429 p. Available from: https://iris.who.int/ handle/10665/208825
Kemnic TR, Gulick PG. HIV antiretroviral therapy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513308/
Adiningsih S, Widiyanti M, Natalia EI, Wahyuni T. CD4+ dan faktor yang memengaruhi kepatuhan terapi antiretroviral pada orang dengan HIV/AIDS di Jayapura. Buletin Penelitian Kesehatan. 2018;46(2):87–96. Doi: 10.22435/bpk.v46i2.306
HIV – Prevalence of HIV among adults aged 15 to 49 (%) [Internet]. [cited 2023 Oct 13]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-hiv-among-adults-aged-15-to-49-(-)
Rohmatullailah D, Fikriyah D. Faktor risiko kejadian HIV pada kelompok usia produktif di Indonesia. Bikfokes. 2021;2(1):45. Doi: 10.51181/bikfokes.v2i1.4652
Riono P, Challacombe SJ. HIV in Indonesia and in neighbouring countries and its social impact. Oral Diseases. 2020;26(S1):28–33. Doi: 10.1111/odi.13560
Frank TD, Carter A, Jahagirdar D, Biehl MH, Douwes-Schultz D, Larson SL, et al. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. The Lancet HIV. 2019;6(12):e831–59. Doi: 10.1016/S2352-3018(19)30196-1
Ladyani F, Kiristianingsih A. Hubungan antara jumlah CD4 pada pasien yang terinfeksi HIV/AIDS dengan infeksi oportunistik di Rumah Sakit Umum Abdul Moeloek Bandar Lampung tahun 2016. JK Unila. 2019;3(1):34–41. Doi: https://doi.org/10.23960/jkunila3134-41
CDC. Centers for Disease Control and Prevention. 2022 [cited 2023 Oct 13]. HIV and Men. Available from: https://www.cdc.gov/hiv/group/gender/men/index.html
Cordeiro SA, Lopes TCP, Boechat AL, Goncalves RL. Weight loss and mortality in people living with HIV: a systematic review and meta-analysis. Principles and Practice of Clinical Research (PPCR). 2024;24(1):34. Doi: 10.1186/s12879-023-08889-3
Williams B, Waters D, Parker K. Evaluation and treatment of weight loss in adults with HIV Disease. Am Fam Physician. 1999;60(3):843–54. Available from: https://pubmed.ncbi.nlm.nih.gov/10498111/
Koethe JR, Jenkins CA, Lau B, Shepherd BE, Justice AC, Tate JP, et al. Rising obesity prevalence and weight gain among adults starting antiretroviral therapy in the United States and Canada. AIDS Res Hum Retroviruses. 2016;32(1):50–8. Doi: 10.1089/aid.2015.0147
Siddiqui J, Samuel SK, Hayward B, Wirka KA, Deering KL, Harshaw Q, et al. HIV-associated wasting prevalence in the era of modern antiretroviral therapy. AIDS. 2022;36(1):127–35. Doi: 10.1097/ QAD.0000000000003096
Zhu J, Huang H, Wang M, Zhang Y, Mo J, Tian W, et al. High baseline body mass index predicts recovery of CD4+ T lymphocytes for HIV/AIDS patients receiving long-term antiviral therapy. PLoS One. 2022;17(12):e0279731. Doi: 10.1371/journal.pone.0279731
Blashill AJ, Mayer KH, Crane HM, Grasso C, Safren SA. Body mass index, immune status, and virological control in HIV-infected men who have sex with men. J Int Assoc Provid AIDS Care. 2013;12(5):319–24. Doi: 10.1177/2325957413488182
Jiang J, Qin X, Liu H, Meng S, Abdullah AS, Huang J, et al. An optimal BMI range associated with a lower risk of mortality among HIV-infected adults initiating antiretroviral therapy in Guangxi, China. Sci Rep. 2019;9(1):7816. Doi: 10.1038/s41598-019-44279-z
Naidoo K, Yende-Zuma N, Augustine S. A retrospective cohort study of body mass index and survival in HIV infected patients with and without TB co-infection. Infectious Diseases of Poverty. 2018;7(1):35. Doi: 10.1186/s40249-018-0418-3
Lelisho ME, Wotale TW, Tareke SA, Alemu BD, Hassen SS, Yemane DM, et al. Survival rate and predictors of mortality among TB/HIV co-infected adult patients: retrospective cohort study. Sci Rep. 2022;12(1): 18360. Doi: 10.1038/s41598-022-23316-4
Gumarianto RS, Lardo S, Chairani A. Hubungan antara hitung jumlah cd4 dengan kejadian wasting syndrome pada pasien HIV/AIDS di RSPAD Gatot Soebroto periode Januari-Desember 2020. Jurnal Kedokteran dan Kesehatan. 2022;9(2):133–42. Doi: https://doi.org/10.32539/JKK.V9I2.16975
Farhadian M, Mohammadi Y, Mirzaei M, Shirmohammadi-Khorram N. Factors related to baseline CD4 cell counts in HIV/AIDS patients: comparison of poisson, generalized poisson and negative binomial regression models. BMC Res Notes. 2021;14(1):114. Doi: 10.1186/s13104-021-05523-w
Paramadika CA, Purnamasidhi C, Sukmawati DD, Gayatri AAAY, Utama S, Somia KA, et al. Relationship between CD4 levels, viral load, and the number of opportunistic infections among patients with HIV infection at Sanglah General hospital Denpasar. Jummec. 2023;26(1):115–21. Doi: https://doi.org/ 10.22452/jummec.vol26no1.17
Framasari DA, Flora R, Sitorus RJ. Infeksi oportunistik pada ODHA (orang dengan HIV/AIDS) terhadap kepatuhan minum ARV (antiretroviral) di kota Palembang. Jambi Medical Journal. 2020;8(1):67–74. Doi: https://doi.org/10.22437/jmj.v8i1.9374
Dafitri IA, Medison I, Mizarti D. Laporan Kasus TB paru koinfeksi HIV/AIDS. YARSI Medical Journal. 2020;28(2):21–31. Doi: https://doi.org/10.33476/jky.v28i2.1420
World Health Organization WHO. Global Tuberculosis Report [Internet]. World Health Organization; 2022 [cited 2023 Nov 8]. Available from: https://iris.who.int/bitstream/handle/10665/363752/9789240061729-eng.pdf?sequence=1
World Health Organization WHO. Fakta-fakta Utama Tuberkulosis. 2022 [cited 2023 Nov 8]. Tuberkulosis. Available from: https://www.who.int/indonesia/news/campaign/tb-day-2022/fact-sheets
Kementerian Kesehatan Republik indonesia. Petunjuk Teknis Penanganan Infeksi Laten Tuberkulosis tahun 2020 [Internet]. 2020 [cited 2023 Nov 8]. Available from: https://tbindonesia.or.id/pustaka_tbc/petunjuk-teknis-penanganan-infeksi-laten-tuberkulosis-tahun-2020/
Bruchfeld J, Correia-Neves M, Källenius G. Tuberculosis and HIV Coinfection. Cold Spring Harb Perspect Med. 2015;5(7):a017871. Doi: 10.1101/cshperspect.a017871
Vaillant AAJ, Naik R. HIV-1–associated opportunistic infections. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539787/
Jayani I, Susmiati, EWinarti, Sulistyawati W. The correlation between CD4 count cell and opportunistic infection among HIV/AIDS patients. J Phys: Conf Ser. 2020;1569(3):032066. Doi: 10.1088/1742-6596/1569/3/032066
Shaleh AS, Fahrial, Siregar ML, Jamil KF. CD4 descriptions at various clinical HIV/AIDS stages with tuberculosis and non-tuberculosis opportunistic infections at dr. Zainoel Abidin hospital in Banda Aceh, Indonesia. IOP Conf Ser: Earth Environ Sci. 2018;125:012032. Doi: 10.1088/1755-1315/125/1/012032
Olawuan A, Subronto YW, Rintiswati N. Factors influencing increases in CD4 cell counts of HIV/AIDS patients receiving antiretroviral therapy in Kupang, East Nusa Tenggara. Proceeding 1st International Conference Health Polytechnic of Kupang. 2018;472–82.
Hasabi IS, Shivashankarappa AB, Kachapur C, Kaulgud RS. A study of compliance to antiretroviral therapy among HIV infected patients at a tertiary care hospital in North Karnataka. J Clin Diagn Res. 2016;10(5):OC27–31. Doi: 10.7860/JCDR/2016/17948.7792
Nainggolan O, Sasmithae L, Widayati R. The effect of antiretroviral therapy (ART) duration on CD4 counts in human immunodeficiency virus (HIV) patients in dr. Doris Sylvanus Regional Hospital. Jurnal Kedokteran Brawijaya. 2023;32(4):228–32. Doi: https://doi.org/10.21776/ub.jkb.2023.032.04.5
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