Clinical correlation of CD4 count and dry eye disease (DED) severity among Human Immunodeficiency Virus (HIV) patients: A case study in Voluntary Counseling and Testing Clinic RSUP Prof Ngoerah, Bali

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Introduction: Dry eye disease (DED) is a condition affecting the surface of the eye and the stability of tears, influenced by various factors. It has been documented as one of the most common ocular issues in the front segment among individuals with HIV, typically appearing in the later stages of the disease. The study sought to examine the clinical relationship between CD4 count and the severity of the condition. Method: This study was conducted as a cross-sectional analysis within a hospital setting, involving 75 HIV-positive patients (140 eyes) aged between 18 and 50 years. These patients were referred to the ophthalmology clinic in the Voluntary Counseling and Testing (VCT) center due to complaints related to ocular surface issues, and they were enrolled in the study. All patients underwent a thorough ophthalmological assessment, including the completion of a dry eye questionnaire, specifically the Ocular Surface Disease Index (OSDI), and measurement of tear film break-up time (TBUT). Results: The research revealed a notable moderate positive correlation between CD4 count and TBUT (r=0.509; p=0.005), and a negative correlation with OSDI score (r=-0.252, p=0.035). Significant differences were observed in CD4 count between mild and moderate dry eyes (p=0.005) as well as between mild and severe dry eyes (p=0.005). No significant difference was found between moderate and severe dry eyes (p=0.435). The severity of dry eye in HIV patients appears to vary across different clinical stages of the disease, coinfection statuses, and treatment histories, although these differences did not reach statistical significance in the results. Conclusion: A correlation exists between CD4 count and the severity of dry eye disease among HIV patients. HIV patients with lower CD4 counts are at a higher risk of developing severe dry eye disease.