Vol. 3, Issue 3 (2018)
A clinical study of newly diagnosed HIV patients at VCTC, Wenlock hospital with correlation to CD4+ at presentation
Author(s): Sandeep Parekh, Muralidhara Yadiyal B, Himanshu Arora
Abstract: Objectives: 1.To study the baseline values of CD4+ count in patients newly diagnosed to be infected with Human Immunodeficiency Virus(HIV) by the Voluntary Counselling And Testing Centre (VCTC) and hence determine how early during the natural course of the disease these patients are detected by VCTC. 2. To study the correlation between CD4+ cell counts and various opportunistic infections in HIV. Methods: Study Site: Voluntary Counselling and Testing Centre (VCTC), Wenlock Hospital, Mangalore, Karnataka Design: Cross Sectional Study Subjects: Subjects under study were hundred consecutive newly diagnosed HIV patients in VCTC of all age groups and either gender, either asymptomatic or presenting with one or other opportunistic infections. Results: Of the 100 patients studied between Sep 2007 and Mar 2009, 74% were males and 26% were females with male to female ratio of 2.8:1. The age at presentation varied from 14 yrs to 55 yrs with the majority between 35 - 40 yrs (28%). 99% of the study subjects acquired HIV through heterosexual contact. Of the 98 patients who were symptomatic, 78% had fever, 70% had cough, 66% had weight loss. Other symptoms included dyspnea (28%) and diarrhea (10%). Oropharyngeal candidiasis was the commonest opportunistic infection at presentation (76%) followed by tuberculosis (54%) of which meningeal tuberculosis was the commonest form (14%). Other tuberculous infections detected were pulmonary (12%), lymphadenitis (10%), disseminated (8%), pleural effusion (4%), miliary (2%), abdominal (2%) and endometrial (2%).Other opportunistic infections included pneumocystis pneumonia (10%), cryptosporidium (6%), herpes zoster (4%) and cryptococcal meningitis (4%). The minimum CD 4 count among the individuals studied was 10 cells/μl whereas the maximum was 499 cells/μl with a mean value of 180 cells/μl. Majority had a CD 4 count of ≤ 200 cells/μl (64%). 62 of the 76 patients with candidiasis had CD 4 count <200. All 14 patients diagnosed to have meningeal tuberculosis had a CD 4 count of < 200. The majority of pulmonary tuberculosis occurred between a CD 4 count of 200-400 cells/μl. All the other extrapulmonary forms of tuberculosis occurred most frequently at a CD 4 count of < 200 cells/μl. All cases of pneumococcal pneumonia, cryptococcal meningitis, majority of herpes and cryptosporidium infections occurred at a CD 4 count of <200 cells/μl. Conclusion: Despite the efforts being put by the Government of India for early detection of HIV infection by establishing VCTCs in every state, we were unable to trace individuals at an earlier stage in the course of HIV infection. The patients being diagnosed with HIV infection presented with one or more of the opportunistic infections and frequently had a CD 4+ count < 200 cells/μl. This calls for increasing awareness about HIV in the general population so as to identify the disease at the earliest.