Perbedaan angka CD4 penderita HIV dengan gangguan kognitif dan tanpa gangguan kognitif

WIDYADHARMA, I Putu Eka, dr. Sekar Satiti, Sp.S(K)

2009 | Tesis | S2 Ilmu Kedokteran Klinik

Latar Belakang Hubungan antara angka CD4 limfosit rendah dengan komplikasi neurologi telah diketahui sejak pengenalan highly active antiretroviral therapy (HAART). Individu dengan angka CD4 limfosit kurang dari 200 sel/mm3 cenderung lebih mudah mengalami komplikasi neurologi terkait infeksi termasuk pula HIV ascociated dementia (HAD), dan risiko akan meningkat seiring dengan penurunan angka CD4 limfosit. Tujuan Mengetahui proporsi gangguan kognitif pada pasien HIV yang menjalani rawat jalan di RSUP Dr. Sardjito Yogyakarta dan menilai apakah ada perbedaan angka CD4 limfosit pada penderita HIV dengan gangguan NK dan tanpa gangguan NK. Metodologi Sebuah penelitian cross sectional dengan pengambilan sample konsekutif. Subjek berusia antara 15-50 tahun tanpa riwayat stroke, trauma kepala, tumor otak dan penyakit Parkinson dibagi menjadi 2 kelompok (CD4 > 200 cel/mm3 dan ≤200 cel/mm3. fungsi kognitif diukur menggunakan MMSE dan dispesifikasi untuk setiap domain. Digit span dan Trail Making test B ditambahkan untuk mengukur fungsi memori jangka pendek dan kecepatan motorik. Setiap subjek dilakukan pemeriksaan darah untuk mengetahui angka CD4 limfosit. Hasil Sembilan puluh enam pasien masuk dalam kriteria inklusi dan eksklusi. Kejadian gangguan NK sebesar 33,3%. Analisis univariat menunjukkan kemaknaan perbedaan angka CD4 limfosit penderita HIV dengan gangguan NK dan tanpa gangguan NK (p=0.02). Angka CD4 berbeda bermakna terhadap gangguan semua domain fungsi kognitif pada MMSE dan juga gangguan short term memory dan processing speed. Simpulan Proporsi gangguan kognitif pada penderita HIV tinggi. Tidak terdapat perbedaan angka CD4 limfosit pada penderita HIV dengan gangguan NK dan tanpa gangguan NK.

Background The relationship between low absolute CD4 lymphocyte count and neurological complications is well established in the era preceding highly active antiretroviral therapy (HAART). Individuals with CD4 lymphocyte counts below 200 cells/mm3 were considered highly vulnerable to neurological complications associated with infection including HAD (HIV ascociated dementia), and the risk increased with further reductions in CD4 lymphocyte count. Objective To assess the proportion of cognitive decline among HIV outclinic patient Sardjito General Hospital Yogyakarta and to determine whether the difference of CD4 count between HIV positive patients with cognitive decline and without cognitive decline. Method A cross sectional study with consecutive sampling. Subject eligible were 15-50 years of age, without a history of stroke, brain injury, CNS tumor and Parkinson’s disease wich devided into 2 groups (CD4 > 200 cel/mm3 and ≤200 cel/mm3). Cognitive function was measured by using MMSE and specified for each domain. Digit span and Trail Making Test B were added to further analyze short term memory and motor processing speed and they perform CD4 count in their blood. Result Ninety six patients fulfill inclution and exclution criteria. proportion of cognitive decline was 33.3% among HIV patient. Univariate analysis showed significant difference of CD4 count between HIV positive patients with cognitive decline and without cognitive decline (p=0.02). CD4 count was significantly different in the decline of all cognitive domain on MMSE, also in the decline of short term memory and processing speed. Conclusion There are high of cognitive decline among HIV outclinic patient Sardjito General Hospital Yogyakarta. CD4 count are difference between HIV positive patients with cognitive decline and without cognitive decline.

Kata Kunci : Angka CD4 limfosit,Gangguan kognitif,Penderita HIV ; low CD4 lymphocyte count, Cognitive decline, HIV patient