Angka CD4 rendah sebagai faktro risiko neuropati sensorik HIV

ROSYADI, Chairil Adam, dr. Imam Rusdi, Sp.S(K)

2010 | Tesis |

Latar belakang: Sekitar 35-63% pasien dengan HIV positif mengalami komplikasi sistem saraf, baik pusat maupun perifer. Neuropati sensorik HIV, terutama mengenai serabut saraf kecil, merupakan bentuk neuropati perifer tersering pada infeksi HIV. Diduga ada beberapa faktor risiko yang berperan terhadap munculnya neuropati sensorik pada infeksi HIV diantaranya adalah angka CD4 yang rendah. Tujuan: Untuk mengetahui angka CD4 rendah sebagai faktor risiko neuropati sensorik pada penderita HIV dengan menghitung odds ratio (OR). Metode: Penelitian ini menggunakan rancangan kasus-kontrol berbasis rumah sakit. Penelitian mengambil sampel penderita HIV yang datang ke poliklinik Edelweis RSUP Dr. Sardjito Yogyakarta selama kurun waktu April 2010 sampai Juli 2010. Angka CD4, angka CD4 nadir, tinggi badan, durasi HIV, terapi dan lama durasi dNRTI dan status anemia diperiksa. Neuropati sensorik HIV diskrining dengan skala LANSS. Analisis statistik menggunakan uji Chi-Square dengan alternatif uji Fisher. Analisis multivariat menggunakan uji regresi logistik dengan neuropati sensorik sebagai variabel dependen utama. Hasil dianggap bermakna secara statistik apabila nilai p<0.05. Hasil: Delapan puluh delapan pasien HIV bepartisipasi dalam penelitian ini (40 pasien dalam setiap kelompok). Angka CD4 ≤ 200 sel/mm3 meningkatkan risiko munculnya neuropati sensorik hingga 3 kali lipat (OR= 3,78; 95% CI: 1,55–9,20; p=0,003). Variabel lain yang memiliki hubungan dengan kejadian neuropati sensorik adalah angka CD4 nadir ≤ 50 sel/mm3 (OR= 3,50; 95% CI: 1,43–8,56; p=0,005), terapi dNRTI (OR= 3,28; 95% CI: 1,33- 8,10; p=0,009) dan status anemia (OR= 2,52; 95% CI: 1,06–5,95; p=0,033). Pada analisis multivariat, hanya angka CD4 ≤ 200 sel/mm3 (aOR= 3,44; 95% CI: 1,29–9,14; p=0,013) dan terapi dNRTI (aOR= 3,36; 95% CI: 1,25–9,03; p=0,016) yang merupakan faktor risiko independen terhadap kejadian neuropati sensorik HIV. Simpulan: Angka CD4 rendah merupakan faktor risiko terjadinya neuropati sensorik pada penderita HIV. Didapatkan hubungan yang signifikan antara angka CD4 rendah dengan kejadian neuropati sensorik HIV.

Background: Approximately 35-63% of HIV positive patients develop complications in the nervous system, both centrally and peripherally. HIV associated sensory neuropathy, specifically affected small nerve fibers, is the most common form of peripheral neuropathy in HIV infection. Presumably there are some risk factors that contribute to the development of sensory neuropathy in HIV infection including low CD4 cell count. Objective: To assess lower CD4 cells count as a risk factor for sensory neuropathy in HIV patients by calculating the odds ratio (OR). Method: The current study design was hospital-based case control study. The samples consisted of adult HIV patients who visited Edelweis clinic of Dr. Sardjito hospital Yogyakarta between April and July 2010. Current CD4 count , nadir CD4 count, height, HIV duration, treatment received and dNRTI duration and anemia status were measured. HIV sensory neuropathy were screened by LANSS scale. Statistical analysis was performed using Chi-Square test with Fisher's exact test as alternative. Multivariate analysis was completed by logistic regression using sensory neuropathy as the main dependent variable. The p-value <0.05 regarded as statistically significant. Results: Eighty eight patients with HIV were included in this study (44 patients in each group). CD4 ≤ 200 cell/mm3 increased the risk of sensory neuropathy up to three-fold (OR= 3.78; 95% CI: 1.55-9.20; p=0.003). Others variables that had a relationship with the development of sensory neuropathy were nadir CD4 count ≤ 50 mm3 (OR= 3.50; 95% CI: 1.43-8.56, p=0.005), dNRTI treatment (OR= 3.28; 95% CI: 1.33-8.10; p=0.009) and anemia status (OR = 2.52; 95% CI:1.06-5.95; p=0.033). On multivariate analysis, only CD4 ≤ 200 cell/mm3 (aOR= 3.44; 95% CI: 1.29-9.14; p=0.013) and treatment with dNRTI (aOR= 3.36; 95% CI: 1.25-9,2003; p=0.016) were independent risk factors for HIV associated sensory neuropathy. Conclusion: The low CD4 count is a risk factor for sensory neuropathy in HIV patients. There was a significant correlation between low CD4 cell count with the incidence of HIV associated sensory neuropathy.

Kata Kunci : CD4,HIV,Sensory neuropathy,Risk factor, sensory neuropathy, risk factor