Abstract
The relationship between low absolute CD4 lymphocyte count and neurological complications is well established in the era preceding highly active antiretroviral therapy (HAART). The aims of this study 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. 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 d”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. 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. 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.
Highlights
Worldwide development of infection of human immunodeficiency virus-1 (HIV-1) and acquired immune deficiency syndrome (AIDS) is the dangerous stage, with an estimated growth of more than 35 million infections in 2001 to 38 million in 2003, and more than 20 million deaths since 1981.1At first, most serious neurological symptoms occur at the stage of systemic disease of HIV-1 and the prevalence of HAD estimated 20-30% in individuals with T-cell cluster of differentiation 4 (CD4) count is low
Data from the HIV Neurobehavioral Research Center (HNRC) indicates that the asymptomatic subject has a level of neuropsychological disorders as much as two-fold compared with seronegative control have risk subjects (35.3% vs. 17.0%), and the level of disturbance increases associated with the worsening of disease (55.8% for individuals with minor infections, or the stage of the Center for Disease Control [CDC] B; 58.1% for individuals with an opportunistic infection such as AIDS)
CD4 lymphocyte count has only a very weak correlation with cognitive dysfunction, the speed of CD4 cell decline may be associated with worsening of neuropsychological disorders.[3]
Summary
Worldwide development of infection of human immunodeficiency virus-1 (HIV-1) and acquired immune deficiency syndrome (AIDS) is the dangerous stage, with an estimated growth of more than 35 million infections in 2001 to 38 million in 2003, and more than 20 million deaths since 1981.1At first, most serious neurological symptoms occur at the stage of systemic disease of HIV-1 and the prevalence of HAD estimated 20-30% in individuals with T-cell cluster of differentiation 4 (CD4) count is low. Data from the HIV Neurobehavioral Research Center (HNRC) indicates that the asymptomatic subject has a level of neuropsychological disorders as much as two-fold compared with seronegative control have risk subjects (35.3% vs 17.0%), and the level of disturbance increases associated with the worsening of disease (55.8% for individuals with minor infections, or the stage of the Center for Disease Control [CDC] B; 58.1% for individuals with an opportunistic infection such as AIDS). CD4 lymphocyte count has only a very weak correlation with cognitive dysfunction, the speed of CD4 cell decline may be associated with worsening of neuropsychological disorders.[3] The other immunological indicators (such as beta-2 microglobulin serum) has only a weak correlation with the neuropsychological ability. A person with AIDS, a higher viral load in the cerebrospinal fluid associated with a greater tendency towards neuropsychological abnormalities, this relationship does not seem to apply to a person who does not immunocompromise significantly (who have a CD4 count of over 200).[4]
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