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

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.