Viral Load and Cluster of Differentiation 4 (CD-4) Values in Human Immunodeficiency Virus (HIV) Patients as a Marker of Sexually Transmitted Disease / Nilai Viral Load dan Cluster of Differentiation 4 (CD-4) pada Pasien Human Immunodeficiency Virus (HIV) sebagai Penanda Infeksi Menular Seksual

Human immunodeficiency virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) infection is a major problem in developing countries. Co-infection with sexually transmitted infections (STIs) in HIV patients is a comorbid factor increasing the risk of HIV and STI transmission. CD4 T lymphocyte cell levels and viral load are used for immunologic and virologic success of HIV/AIDS patients. Studies linking CD4 T lymphocyte counts, viral load and STI incidence in HIV/AIDS patients are few and variable. This research aim to evaluate the CD4 and viral load values in HIV/AIDS patients at Dr. Moewardi Hospital with the incidence of STIs. Retrospective study using secondary data from the medical records of the Voluntary Counseling and Testing (VCT) clinic at Dr. Moewardi Hospital for the period January 2022 - December 2024. Sexually transmitted infections diagnosis was based on syndromic approach. Data CD4 of STI patients with HIV/AIDS were recorded for statistical processing using SPSS version 26. Numerical data were tested for normality using the Kolmogorov-Smirnov test (p>0.05). Normally distributed data were subjected to unpaired t-test, non-normally distributed data were subjected to Mann-Whitney test, categorical data were subjected to chi-square test with a significance of p<0.05. CD4 data were then assessed for sensitivity, specificity and cut-off values. Cases of HIV patients with STIs were predominantly male with an average age of 33.94 years. Statistical analysis showed gender (p=<0.001), occupation (p=0.018) age (p<0.001), and ARV duration (p=0.037), while education level (p=0.448) and viral load (p=0.417). CD4 count (p=0.027) had p<0.05, AUC for CD4 was 0.648 with p=0.030, cutoff 459.5, sensitivity 66.7% and specificity 62.5%, OR=3.33 and p=0.013. There is an association between CD4 levels and the incidence of STIs in HIV patients with a sensitivity of 66.7%, specificity of 62.5% and a cutoff value of 459.5, HIV patients with CD4 <459.5 have a risk of STIs by 3.33 times compared to HIV patients who have CD 4 ≥459.5 (OR = 3.33; p = 0.013).

Infeksi Human immunodeficiency virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) merupakan masalah utama di negara berkembang. Koinfeksi infeksi menular seksual (IMS) pada pasien HIV merupakan faktor komorbid risiko transmisi HIV dan IMS. Keberhasilan terapi dinilai dari kadar sel limfosit T CD4 dan viral load. Studi yang menghubungkan jumlah sel CD4, viral load dan angka kejadian IMS pada pasien HIV/AIDS hingga kini hanya sedikit dan hasil bervariasi. Penelitian ini bertujuan untuk mengevaluasi nilai CD4 dan viral load pada pasien HIV/AIDS di RSUD dr. Moewardi dengan angka kejadian IMS. Penelitian retrospektif menggunakan data sekunder rekam medik klinik Voluntary Conseling and Testing (VCT) RSUD dr. Moewardi periode Januari 2022 – Desember 2024. Diagnosis IMS ditegakkan berdasarkan pendekatan sindrom. Data CD4 pasien IMS dengan HIV/AIDS dicatat untuk diolah secara statistik menggunakan SPSS versi 26. Data numerik dilakukan uji normalitas menggunakan uji kolmogorov-smirnov (p>0.05). Data yang terdistribusi normal dilakukan uji t tidak berpasangan, data yang tidak terdistribusi normal dilanjutkan uji mann-whitney, data kategorik menggunakan uji chi-square dengan signifikansi p<0,05. Data CD4 kemudian dinilai untuk melihat sensitivitas, spesifisitas dan nilai cut-off. Kasus pasien HIV dengan IMS didominasi laki-laki dengan rerata usia 33,94 tahun. Analisis statistik menunjukkan jenis kelamin (p=<0.001), Pekerjaan (p=0.018) usia (p<0.001), dan lama ARV (p=0.037), sedangkan tingkat pendidikan (p=0.448) dan viral load (p=0.417). Hasil pemeriksaan CD4 (p=0.027) mendapatkan nilai p<0.05, AUC untuk CD 4 sebesar 0.648 dengan nilai p=0.030, cut-off 459,5, sensitivitas 66,7% dan spesifisitas 62,5%, OR=3,33 dan p=0,013. Terdapat hubungan antara kadar CD4 dengan kejadian IMS pada pasien HIV dengan sensitifitas sebesar 66,7%, spesifisitas 62,5% dan nilai cut-off 459,5, pasien HIV dengan CD4 <459,5 berpeluang risiko terjadi IMS sebesar 3,33 kali dibandingkan dengan pasien HIV yang memiliki CD 4 ≥459,5 (OR=3,33; p=0,013).