OBJECTIVE To describe CD4 evaluation and its association with several clinical presentation of pediatric HIV infection after six month first line antiretroviral (ARV)
consumption.
METHODS Cross sectional study of children with HIV infection was conducted from 2014 to 2018 at Dr.Soetomo Academic Hospital. Data were collected from 50 medical record, aged between 0-18 years old. HIV confirmation based on three method serology tests. PCR RNA/DNA and presumptive HIV was used for children < 18 month. Demographic data, evaluation of CD4, opportunistic infection, also weight loss after six month first line antiretroviral therapy were analyzed using chi-square with p<0.05 considered significant.
RESULTS Total 50 positive HIV children, 52% boys, 80% from outside Surabaya city, 28% are orphans, and 34% of parents were unemployment. At first admission, 90% children were symptomatic with clinical presentation were oral candidiasis (31%), anemia (29%) and skin lesion (furunculosis, impetigo, pruritic eruption) (13%). Initial nutritional status were 50% with moderate and severe malnutrition, and 10% with overweight and obese. Most of opportunistic infections were recorded as pulmonary TB in 44%, and persistent diarrhea in 31%. Weight loss observed in 26% after 6 month ARV therapy. From 37 patient who had
CD4 evaluation 59% had CD4 level enhancement. Several factors associated with enhancement of CD4 level were improvement of opportunistic infection (PR 5.9; 95%CI 1.4 to 25.2; P=0.013) and nutritional status (PR 0.1; (5%CI 0.2 to 0.5; P= 0.002)
CONCLUSION The majority of children with HIV infection present with opportunistic infection as initial manifestation and diverse nutritional status. CD4 level evaluation after 6 month first line ARV had association with initial nutritional status and improvement of opportunistic infection.