Shofa Annesa Hidayat, Ismi Zuhria, Muhammad Vitanata Arfijanto, Reni Prastyani

The CD4 Count and Viral Load Differences in HIV Patients with and without Infectious Posterior Uveitis at a Tertiary Hospital in Indonesia

Introduction

The cd4 count and viral load differences in hiv patients with and without infectious posterior uveitis at a tertiary hospital in indonesia. Study reveals significantly lower CD4 counts in HIV patients with infectious posterior uveitis compared to those without, at an Indonesian hospital. Viral load showed no difference.

Abstract

Introduction: The human immunodeficiency virus (HIV) compromises the immune system, making the monitoring of cluster of differentiation (CD4) counts and viral loads critical for assessing disease progression and opportunistic infection risks. Eye-related manifestations, such as uveitis, are common among HIV patients. The purpose of this study was to investigate the differences in CD4 count and viral load between HIV patients with infectious posterior uveitis and those without at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Methods: A retrospective study with an analytical observational design was conducted using the medical records of 75 HIV patients. The examined variables included CD4 count and viral load as independent variables, alongside the incidence and absence of infectious posterior uveitis as dependent variables. The inclusion criteria were HIV patients with regular follow-ups, thereby excluding those with irregular follow-ups. The analysis used the Mann-Whitney test, with p<0.05 indicating a statistically significant difference. Results: All 75 samples met the inclusion criteria for analysis. The majority of the patients were male (64%) and within the age range of 31 to 40 years (44%). Patients with infectious posterior uveitis had significantly lower CD4 counts (p<0.05) compared to those without the disease. However, no significant differences in viral loads (p>0.05) were observed between patients with posterior uveitis and those without. Conclusion: CD4 counts differ significantly between patients with infectious posterior uveitis and those without, while viral loads show no considerable differences. Highlights: 1. This study highlights the differences in cluster of differentiation (CD4) lymphocyte count and viral load between HIV patients with infectious posterior uveitis and those without. 2. The findings may provide new insights into the immunological mechanisms underlying infectious posterior uveitis in persons living with HIV. 3. This work contributes to determining the factors that affect the development of infectious posterior uveitis and explores the potential use of CD4 lymphocyte count and viral load as biomarkers for the diagnosis and management of the disease.

Review

This study investigates the critical immunological markers, CD4 count and viral load, in HIV patients with and without infectious posterior uveitis at a tertiary hospital in Indonesia. The research addresses an important clinical question given the prevalence of ocular manifestations in HIV. The retrospective, analytical observational design effectively utilized existing medical records to compare these two patient groups. A key strength is the clear identification of a statistically significant difference in CD4 counts, with patients presenting with infectious posterior uveitis exhibiting notably lower counts. This finding reinforces the established role of CD4 levels as a crucial indicator of immune compromise and risk for opportunistic infections, including those affecting the eye. The study's focus on a specific regional population also adds valuable data to the global understanding of HIV-related complications. Despite its contributions, the study presents several limitations that warrant consideration. The retrospective nature, while practical, inherently restricts the ability to establish causality and is susceptible to potential biases from data collection and completeness in medical records. A significant omission from the abstract is the lack of information regarding the patients' antiretroviral therapy (ART) status. ART critically influences both CD4 counts and viral loads, and its absence as a controlled variable or stratification factor could significantly confound the results, particularly concerning the non-significant viral load difference. Furthermore, the definition and specific causative agents of "infectious posterior uveitis" are not detailed, which would provide greater precision to the immunological context. The sample size of 75, while sufficient for initial comparison, may limit the generalizability and power to detect more subtle associations or stratify by other relevant clinical factors. Nevertheless, this research provides valuable insights, particularly the finding that significantly lower CD4 counts are associated with infectious posterior uveitis, independent of viral load differences. This suggests that the degree of immune depletion, rather than viral replication activity alone, might be a more potent predictor for this specific ocular complication. Future research should build upon these findings through prospective studies with larger cohorts, meticulously controlling for ART status, duration of HIV infection, and specific etiologies of uveitis. Exploring other inflammatory markers and thoroughly characterizing the types of infectious posterior uveitis would further enhance our understanding. Ultimately, this study underscores the continued utility of CD4 count as a crucial biomarker for risk stratification in HIV patients, especially in resource-limited settings where comprehensive viral load monitoring might be less accessible, thereby guiding better clinical management of ocular complications.

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