PROFILE against opportunistic infections CD4 LEVELS IN PATIENTS Human

Immunodeficiency Virus / Acquired

IMMUNODEFICIENCY SYNDROME ( HIV / AIDS) IN
Hospital DR. BANDA ACEH ABIDIN Zainoel

Fitri Kurnia Jamil

Abstract. HIV disease is still a global health problem, including in Indonesia. The research objective was to
determine the opportunistic infections in HIV patients in dr. Zainoel Abidin Banda Aceh from January 2007
to April 2013. The study was a retrospective descriptive way obtained a total of 73 people with HIV / AIDS
out of the 47 (64%) and 26 women (36%). There are 51 of the 73 patients had IO (70%) and the remaining
22 patients (30%) do not have OI. Pulmonary TB become the most opportunistic infections were 30 cases
(59%). The decline in CD4 levels showed an increased incidence of opportunistic infections in HIV patients.

(JKS 2014; 2: 76-80)

Keywords : HIV, opportunistic infections

Abstract. HIV disease is still a global health problem, Including in Indonesia. The purpose of the study was to
Determine the opportunistic infections in HIV Patients in the dr. Zainoel Abidin Hospital in Banda Aceh since
January 2007 to April 2013 using retrospective descriptive study was Obtained a total of 73 people with HIV /
AIDS than men 47 people (64%) and 26 women (36%). There are 51 of the 73 Patients had OI (70%) and the
remaining 22 Patients (30%) did not have OI. Pulmonary TB be the most opportunistic infections roomates 30
cases (59%). Decreased levels of CD4 Showed an Increased incidence of opportunistic infections in HIV
Patients. ( JKS 2014; 2: 76-80)

Keywords: HIV, opportunistic infections

preliminary
against his HIV infection, but not on ARVs
Infectious diseases HIV / AIDS is still a global
because factor
health problem, including in Indonesia. 1 Currently
psychosocial or economic; 3) some patients were
HIV has
given antiretroviral drugs, but failed to achieve
number of deaths
virological and immunological response adequate
high, which can threaten the lives of HIV patients for factors - factors associated with adherence
not only from the virus itself, but an opportunistic
pharmacokinetics, or factors - biological factors
infection (OI) and its complications can also cause
that are not explained. Thus, despite the care and
death. 2
mortality figures have declined since their ARVs,
OI remains a major cause of morbidity and
In the United States and countries - industrialized countries mortality of HIV-infected patients. 3
other, although already

IO availability of antiretroviral drugs but continued

to cause morbidity and mortality for three main
reasons; 1) many patients who are less aware of
his HIV infection and seek medical care when IO
main indicator of disease
they; 2) patient - specific patient alert
Jamil Fitri Kurnia is Lecturer Department of Medicine
Faculty of Medicine University of Syiah Kuala / dr. Zainoel
Abidin Banda Aceh
In Indonesia, since 1999 has been an increase in
the number of PLWHA (people living with HIV /
AIDS) in the group of high risk of acquiring HIV
infection is the commercial sex workers and
injecting drug users (IDUs) in some provinces
such as Jakarta, Riau, Bali, West Java and East
Java so that the province
mentioned classified

1
JOURNAL OF MEDICINE Syiah Kuala Volume 14, Number August 2nd, 2014

as areas with concentrated epidemics Materials and Methods

( concentrated levels of Retrospective descriptive study
epidemic). Papua has entered the level by collecting
widespread epidemic ( generalized all patients with HIV who come to the Clinic Voluntary
epidemic). The estimation results of the year 2009, in Councelling and Testing
Indonesia there are 186,000 HIV-positive people. 4 From (VCT) in dr. Zainoel Abidin Banda Aceh both
situation report outpatient and inpatient care from January 2007
progression of HIV and AIDS in Indonesia until to April
September 2011 recorded the number of people living 2013.
with HIV who receive antiretroviral therapy as much as Data were recorded on medical record book that
22 843 of the 33 provinces and 300 districts / cities, with included age, gender, CD4 count and
the ratio of men and women 3: 1, and the highest
opportunistic infections that accompany. HIV
percentage in the age group 20-29 years. 4
diagnosis is made by a method rapid test and ELISA
and diagnosis
Infections that occur in patients with HIV depends disease IO enforced
on the stage of HIV infection, history by anamnesis, clinical,
infection, virulence from lab and stage of HIV based on WHO criteria,
microorganisms and factors - factors related to the which includes stage I, II,
host ( host related factor). IO can be caused by III, and IV.
bacteria (Ie.
tuberculosis, salmonella infection, etc.), viruses (eg, result
herpes simplex virus, oral hairy leukoplakia, cytomegalovirusO, btained a total of 73 people with HIV / AIDS
etc.), fungi (ie. consists of men - men 47 (64%) and women 26
candidiasis, cryptococcosis, (36%) and
pneumocystis jiroveci, etc.), parasites (eg, the discovery of 12 species of opportunistic infection is
cryptosporidiosis, etc), and some the data before people
Other clinical conditions such as malignancy (ie. receive ARV therapy. Average patient age -
non-Hodgkin's lymphoma, sarcoma average 29 years, the lowest age 2 years and age
kapossi, etc). And also IO can 72-year highs
attack a wide variety of organs, such as the whereas the age group the most
airway, digestive tract, is the age group 26-30 years as many as 22
neurological, skin, and so forth. 2 people (30%). Based on the stage of HIV found as
CD4 count is a way to assess the immune status many as 22 people were in stage I (30%), 5 in
of PLWHA. CD4 complement clinical examination stage II (7%), 44 stage III (60%) and 2 in stage IV
to determine which patients need prophylactic (3%). There are 51 of the 73 patients had IO
treatment of OIs and ARV therapy. Average CD4 (70%) and the remaining 22 patients (30%) do not
cell decline is approximately 70-100 have OI. Pulmonary TB become the most
opportunistic infections were 30 cases (59%) and
cells / mm3 / year, with 24 cases of Chronic Diarrhea (47%) as well as
enhancement after administration of ARVs Oral Candidiasis 21 cases (41%).
between 50-100 cells / mm3 / year. Total
lymphocyte
total (TLC) can not
replace CD4. 4
In this paper will be discussed more deeply about Table 1 Group of people with HIV / AIDS
some opportunistic infections, ie connection with by genius s kel amen
CD4 levels found in HIV / AIDS patients in
No. Gender n Percentage
hospitals. Dr. Zainoel Abidin Banda Aceh since
1 Male 4 64.38%
January 2007 until April 2013. 7
2 woman 2 35.62%
6
Total 7 100.00%
 Fitri Kurnia Jamil, Profile Levels of CD4 against Opportunistic Infections

Table 2 Incidence based groups Table 3 Percentage based on the stage

age HIV clinical m ccording WHO
No. Age N Percentage No. Stadium n Percentage

1 ≤ 5 years 6 8:22% 1 I 22 30.14%

2 6-10 years 1 1:37% 2 II 5 6.85%
3 11- 15 years 0 0.00% 3 III 44 60.27%
4 16-20 years 1 1:37% 4 IV 2 2.74%
5 21-25 years 11 15:07% Total 73 100.00%
6 26-30 years 22 30.14%
7 31-35 years 20 27.40%
8 36-40 years 6 8:22%
9 41-45 years 1 1:37%
10 46-50 years 3 4:11%
11 51-55 years 1 1:37%
12 ≥ 56 years 1 1:37%
Total 73 100.00%

T abel 4 groups of patients d ith and t a npa IO is based on levels of C D4

No CD4 levels IO (+) % IO (-) % Total percentage of Total

1 ≤ 49 24 100% 0 0% 24 32.88%
2 50- 7 88% 1 13% 8 10.96%
149
3 150- 9 64% 5 36% 14 19:18%
249
4 250- 6 60% 4 40% 10 13.70%
349
5 ≥ 350 5 29% 12 71% 17 23:29%
Total 51 cases (69.86%) 22 cases (30.14%) 73 100%

tab e l 5 Group OIs b Erda s arkan levels CD4

No. Opportunistic Infections ≤49 50-149 150 - 249250-349 ≥350 n Percentage

1 Tuberculosis 2 4 3 1 2 30 32.97
0 %
2 Chronic Diarrhea 9 5 3 5 2 24 26.37
%
3 Oral Candidiasis 1 2 3 1 2 21 23:08
3 %
4 colitis 2 1 0 1 0 4 4:40
%
Papular Pruritic
5 Eruption (PPE) 2 1 0 0 0 3 3:30
%
6 Herpez zooster 0 0 1 1 0 2 2:20
%
7 TB lymphadenitis 1 0 0 0 1 2 2:20
%
Pneumocystic carinii
8 pneumonia (PCP) 0 0 1 0 0 1 1:10
%
9 Ankylosing TB 0 0 1 0 0 1 1:10
%
Anal Genital condyloma
10 0 0 0 1 0 1 1:10
%
11 Meningitis TB 1 0 0 0 0 1 1:10
%
12 dermatitis Seborroik 1 0 0 0 0 1 1:10%
Number of Cases IO 49 13 12 10 7 91 100.00%
JOURNAL OF MEDICINE Syiah Kuala Volume 14, Number August 2nd, 2014

From the overall opportunistic infection found in
people with HIV / AIDS, found an increased
incidence of IO that is comparable to the decline
in CD4 cells in patients, which is clearly seen the
number of IO most lower in the levels of CD4 ≥
350 as much as 7 IO, followed by 10 types of IO in
group CD4 levels 250-349, and then increased in
the group of CD4 levels 150-249 as many as 12
kinds of IO, group CD4 count 50-149 as much as
13 IO and the most common type of IO is in the
group of CD4 count ≤ 49 as many as 49 types of
OI.
additional Western Blot, whereas the HIV-specific
diagnostic methods such as virus isolation, antigen
detection, and detection of genetic material of HIV
by PCR is not used. 9 However, because current
tests
Western Blot the cost is still expensive then be
used for diagnostic purposes filter test positive
three times with different reagents. 10
Infection opportunistic occur because
very decreased immunity. CD4 cell counts in the
blood is a reliable indicator for monitoring the
severity of HIV-induced immune damage, and
allows us to take the decision to give
anti-retroviral treatment. 5,9,11

Discussion
Generally, people with HIV / AIDS are found Pattern infection opportunistic different
The most frequent age was various country
productive age group (15-49 years) of 82.9%, dependent pattern microorganisms that
above 50 years of age in most studies ranges exist in the body or
from 11% and more than 60 years of 3%. 5 This is patient environment. Infection

probably due to the influence of sexual activity is Opportunistic often found in this study were 30
still high in the productive age, cases of pulmonary tuberculosis (32.97%) and
chronic diarrhea 24 cases (26.37%) followed by
influence environment and oral candidiasis
profession. Distribution of AIDS cases by sex is as many as 21 cases
more common in men with a ratio of 3: 1. 6 The (23.08%).
pattern of the spread of HIV / AIDS in Indonesia is
similar to other countries where it first appeared Conclusion
among gay, then appeared in high-risk groups of The decline in CD4 levels showed an increased
people behave like injecting drug addicts, incidence of opportunistic infections in HIV
patients, although patients with the same CD4
levels can still have
infection opportunistic
the prostitutes and different.
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