The Association of Syphilis Infection and Other Risk Factors with Immunity of Patients with HIV on Anti-Retroviral Therapy

Pik Siong, B. Rina A. Sidharta, Amiroh Kurniati

Abstract


Syphilis infection, age, gender, sexual behaviour, length of HIV infection and length of ARV treatment are suspected to be associated with amount of cluster of differentiation 4 (CD4+)T-cells (CD4+ T-cell) and CD4+ T-cells: CD8+ T-cells ratio (CD4:CD8) of HIV patients on ARV. However, the evidence remains lacking. The aim of this cross-sectional study on April 24th to June 20th, 2019 was to determine the association of syphilis infection and other risk factors (age, gender, sexual behavior, length of HIV infection and ARV treatment) with the immunity of patients with HIV on ARV based on T CD4+ and CD4:CD8, and got factors those have an influence to T CD4+ and CD4:CD8. Seventy-four subjects with age ≥18 years old with HIV on ARV from Voluntary Counselling Test (VCT) Outpatients of Dr. Moewardi General Hospital in Surakarta (DMGHS) had been examined for syphilis, T CD4+ count and CD4:CD8 in Clinical Pathology Laboratory of DMGHS. Other data had been completed from the anamnesis and VCT data system. All data had been processed with SPSS version 21. Multivariate logistic regression following bivariate analysis of the Chi-Square test was used for categorical variables. Bivariate analysis showed a significant association between age, length of HIV infection and length of ARV treatment to T CD4+ count and significant association between sexual behavior, length of HIV infection, and length of ARV treatment to CD4:CD8 (p<0.05). Multivariate analysis showed that the prevalence of CD4≤500 was higher in male Prevalence Ratio (PR)=3.256; p=0.038) than that of female and subjects aged >42 y.o. compared to those aged >18-42 y.o. (PR=3.451; p=0.047). The PR of CD4:CD8<0.3 in anal sex (PR=3.575; p=0.049) was higher than that of vaginal sex. The PR of CD4≤500 (PR=0.271; p=0.020) and CD4:CD8<0.3 (PR=0.125; p=0.001) in subjects with length of HIV >5 years were lower than those in HIV 0-5 years. Age, gender, and length of HIV potentially affect the probability of T CD4+≤500. Sexual behavior and length of HIV potentially affect the probability of CD4:CD8<0.3. Both CD4 and CD4:CD8 ratio must be tested at baseline and follow-up.


Keywords


T CD4+, CD4:CD8, prevalence ratio, syphilis, HIV, probability

Full Text:

PDF

References


REFERENCES

Mahon C. R., Donald C. L., and George M. Textbook of Diagnostic Microbiology.4th Ed. Missouri: W. B. Saunders Company. 2011: 539-547

Male D., Jonathan, B., David, B. R., and Ivan, M. R., 2013. Immunology. 8th Ed. China: Elsevier. 2013: 277-88

Prabowo, Y. Profil Kesehatan Provinsi Jawa Tengah Tahun 2017. Semarang: Dinas Kesehatan Provinsi Jawa Tengah. 2018

Wahyuningsih, S. Profil Kesehatan Kota Surakarta Tahun 2017. Surakarta: Dinas Kesehatan Kota Surakarta. 2018:55-80. Available from: http://dinkes.surakarta.go.id/profil-kesehatan-kota-surakarta-tahun-2017/ (diunduh 5 September 2018)

Hastuti, R. Peran Faktor Risiko Terhadap Prevalensi Infeksi Menular Seksual dan Infeksi HIV Pada Wanita Pekerja Seks di Surakarta. Universitas Sebelas Maret. Masters thesis. 2018

Chandrasekar, P.H. Syphilis. Editor: Michael S.B. 2017. Available from: https://emedicine.medscape.com/article/229461-overview#showall (diunduh 5 September 2018)

Torok, E., Ed, M., and Fiona, C. Oxford Handbook of Infectious Diseases and Microbiology. 2nd Edition. United Kingdom: Oxford University Press. 2017:333-37; 714-16; 819-42.

Li, Z., Xiaofan, L., Zhiliang, H., Zhenwu, L., Wei, J., Hao, W., Yanqing, G. et al. Syphillis Infection Differentially Regulates the Phenotype and Function of δγ T cells in HIV-1 Infected Patients Depends on the HIV-1 Disease Stage. Frontiers in Immunology. 2017;8:991

Klatt, E.C. Pathology of HIV/AIDS. 30th Edition. Savannah: Mercer University School of Medicine. 2019: 35-100

Tsai, H.C., Shin, Y.Y., Susan, S.J.L., Shue, R.W., and Yao, S.C. Expression of CXCL2 in the Serum and Cerebrospinal Fluid of Patients ith HIV and Syphillis or Neurosyphillis. Inflammation. 2014; 37(3):950-5

Shilaih, M., Alex, M.,Marzel A, Dominique, L.B., Alexandra, U.S., Helen, K., Jim, Y., Alexandra, C. et al. Factors associated with syphilis incidence in the HIV-infected in the era of highly active antiretrovirals. Medicine. 2017; 96(2):e5849

Cassoti J.A.S., Luciana, N.P., Fabiano, J.P.O., and Crispim, C.Jr. Factors Associated with Paradoxical Immune Response to Antiretroviral Therapy in HIV Infected Patients: A Case Control Study. BMC Infectious Diseases. 2011;11:306

Annison, L., Dompreh, A., and Abu, S.Y. The Immunological Response of HIV-Positive Initiating HAART at the Komfo Anokye Teaching Hospital Kumasi, Ghana. Ghana Medical Journal. 2013; 47 (4):164-70

Teshome, W., and Anteneh, A. Predictors of Immunological Failure of Antiretroviral Therapy Among HIV Infected Patients in Ethiopia: A Matched Case Control Study. PLos One. 2014; 9 (12):e115125.

Uppal, S.S., Shashi, V., and P.S. Dhot. Normal Values of CD4 and CD8 Lymphocyte Subsets in Healthy Indian Adults and the Effects of Sex, Age, Ethnicity and Smooking. Cytometry Part B (Clinical Cytometry). 2003; 52B:32-6.

Prasetyo, A.A., and Zaini, K.U. Establishing Mean CD4+ T Cell Values Among Healthy Javanese Adults in Indonesia. South East Asian J Trop Med Public Health. 2015; 46(4):662-8

Yusra, E., Efrida, E., and Elmatris, Sy. Hubungan Karakteristik Klinis dengan Pemulihan Respons Imun Penderita HIV-1 yang Maledapat Terapi Antiretroviral di RSUP Dr. M. Djamil Padang. Jurnal Kesehatan Andalas. 2018; 7(3).

World Health Organization. 2005. Interim WHO Clinical Staging of HIV/AIDS and HIV/AIDS Case Definitions for Surveillance. Afrika: WHO. Pp: 1-15

Moeloek, F.N. Keputusan Maleteri Kesehatan Republik Indonesia Nomor HK.01.07/MALEKES/90/2019 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana HIV. Jakarta: Keputusan Maleteri kesehatan Republik Indonesia. 2019:1-100

Susilowati, T. Faktor –faktor risiko yang berpengaruh terhadap kejadian HIV dan AIDS di Semarang dan sekitarnya: Komunikasi Kesehatan (Edisi 2) P3M AKBID Purworejo. 2011; 2(01).

Leung, V., Jennifer, G., Janet, R., Curtis, C., Robert, S.H., Mona, R.L., Nima, M. et al. Predictors of CD4:CD8 Ratio Normalization and Its Effect on Health Outcomes In The Era of Combination Antiretroviral Therapy. Plos One. 2013:8(10):e77665

Bellissimo, F., Marilia, R.P., Benedetto M.C., Bruno C., and Giuseppe, N. Baseline CD4/CD8 T-Cell Ratio Predicts Prompt Immune Restoration Upon cART Initiation. Curr HIV Res. 2016; 14(6):491-496.

Mussini, C., Patricia, L., Alessandro, C.L., Giuseppe, L., Giulia, M., Emanuele, N., Antonella, C. et al. CD4/CD8 Ratio Normalisation and Non-AIDS-Related Events in Individuals with HIV who Achieve Viral Load Suppression with Antiretroviral Therapy: An Observational Cohort Study. Lancet HIV. 2015; 2(3):e98–e106.

Venter, W.D.F., Matthew, F.C., Mohammed, M., Godspower, A., Natasha, A., Michelle, M.., Nonkululeko, N. et al. CD4 cell count variability with repeat testing in South Africa: Should reporting include both absolute counts and ranges of plausible values? International Journal of STD & AIDS. 2018; 29(11):095646241877176.

Wade, D., Geraldine, D., Said, A., Gaby, H.V., Willy, S.K.U., and Luc, K. WHO Multicenter Evaluation of FACSCount CD4 and Pima CD4 T-Cell Count Systems: Instrument Performance and Misclassification of HIV Infected Patients. J Acquir Immune Defic Syndr. 2014; 66:e98-e107

Iswara, N.P.A.A.P., Sutarsa, I.N., and Sawitri, A.A.S. 2018. Prediktor Immunological Failure pada Pasien HIV/AIDS di Yayasan Kerti Praja, Bali: Studi Kohort Retrospektif. E-Jurnal Medika Udayana. 7(3): 133-139

Adiningsih, S., Mirna, W., Evi, I.N., and Tri, W. 2018. CD4+ dan Faktor yang Mempengaruhi Kepatuhan Terapi Anti Retroviral pada Orang dengan HIV/AIDS di Jayapura. Buletin Penelitian Kesehatan, Vol. 46, No. 2, Juni: 87 – 96

Saktina, P.U., and Bagus, K.S. 2017. Karakteristik Penderita AIDS dan Infeksi Oportunistik di Rumah Sakit Umum Pusat Sanglah Denpasar Periode Juli 2013 sampai Juni 2014. E-Jurnal Medika.Vol. 6 No.3.

Rueda, S., Janet, R., Sean, B.R., Tsegaye, B., Ahmed, B., John, L., John, C. et al. Influence of Employment and Job Security on Pysical and Maletal Health in Adults Living with HIV: Cross-Sectional Analysis. Open Med. 2012; 6(3):118-126.

Kambu Y. Analisis Faktor-Faktor yang Mempengaruhi Tindakan Pencegahan Penularan HIV oleh ODHA di Sorong. Thesis. Fakultas Ilmu Keperawatan Universitas Indonesia. Jakarta. 2012

Shisana, O., Kathryn, R., David, D.C., Nompumelelo, Z., Thomas, R., Busani, N., and Meredith, G.B.E. Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. AIDS Care. 2016; 28(2): 234–241.

Chen, Y., Shengjun, Q., Jan, T., Sam, O., Mikael, J. Thymus-Derived Glucocorticoids Mediate Androgen Effect On Thymocyte Homeostasis. FASEB J. 2010; 24: 5043-51.

Meditz, A.L., Joy, M. F., Ngan, H.L., Kristina, S., Yolanda, S.L., Eoin, P.C., Martin McCarter et al. CCR5 Expression is Reduced in Lymph Nodes of HIV Type 1-Infected Female, Compared With Male, But Does Not Mediate Sex-Based Differences in Viral Loads. The J of Infect Dis. 2014; 209(6):922-30.

Su, S., Shifu, L., Shunxiang, L., Liangmin, G., Ying, C., Jincui, F., Chunyuan, G. Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatmalet Adherence and Outcomes. BioMed Research International. 2016; (4):1-8 .

Nakanjako, D., Isaac, S., Harriet, M.K., Agnes, K., Robert, C., Yukari, C.M., Rose, N. et al. High T-Cell Immune Activation and Immune Exhaustion Among Individuals with Suboptimal CD4 Recovery After 4 Years of Antiretroviral Therapy in An African Cohort. BMC Infectious Diseases. 2011; 11:43

Gras, L., Anouk, M.K.,James, T.G., Ard, I. van S., Christophe, F., Azra, C.G., Frank, M et al. CD4 Cell Counts of 800 Cells/mm3 or Greater after 7 Years of Highly Active Antiretroviral Therapy are Feasible in Most Patients Starting with 350 Cells/Mm3 Or Greater. J Acquir Immune Defic Syndr. 2007; 45:183-192

Xiao, J., Xu, L., Gao, G., Wu, L., Wang, F., Yang, D., and Zhao, H. Syphilis Influences The CD4/CD8 Ratio and A Scoring Model Predicts Normalization of CD4/CD8 Ratio in HIV-Infected Patients. In: 3rd Asia Pacific AIDS & Co-infections Conference. Reviews in Antiviral Therapy & Infectious Diseases. 2018;7:76

Mehandru, S., Michael, A.P., Klara, T.R., Amir, H., Arlene, H., Christine, H., Daniel, B. et al. Primary HIV-1 Infection Is Associated with Preferential Depletion of CD4+ T Lymphocytes from Effector Sites in the Gastrointestinal Tract. The Journal of Experimental Medicine. 2004; 200(6):761-70

Saracino, A., Giuseppe, B., Luigia, S., Anna, V., Pierluigi, C., Nicoletta, L., Laura, M. et al. Chronic Inflammation in a Long-Term Cohort of HIV-Infected Patients According to the Normalization of the CD4:CD8 Ratio. AIDS Research and Human Retroviruses. 2014; 30(12):1178-84

Thornhill, J., Jamie, I., Pontiano, K., David, C., Gita, R., Mauro, S., Giuseppe T. et al. Enhanced Normalisation of CD4/ CD8 Ratio with Earlier Antiretroviral Therapy at Primary HIV Infection. J Acquir Immune Defic Syndr. 2016;73:69-73.




DOI: http://dx.doi.org/10.24293/ijcpml.v26i3.1548

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.