Intensive eye health monitoring

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Relationship between Cluster Differentiation 4 (CD4) and Viral Load levels with Ocular Manifestations in Children with Human Immunodeficiency Virus (HIV) receiving Antiretroviral (ARV) Therapy

Introduction

Human Immunodeficiency Virus (HIV) is a significant public health concern, particularly in children. According to the World Health Organization (WHO), HIV is the fourth leading cause of death and severe systemic complications in children worldwide. In Indonesia, the number of HIV cases in children is increasing significantly, making it essential to understand the impact of HIV on children's health, including their eye health. This study aims to investigate the relationship between cluster differentiation 4 (CD4) levels and viral load (VL) with ocular manifestations in children with HIV who receive antiretroviral (ARV) therapy.

Background

HIV infection in children can lead to various ocular manifestations, ranging from mild conditions such as conjunctivitis to more severe conditions such as retinal detachment. The ocular manifestations in children with HIV are different from those in adults, making it essential to understand the relationship between CD4 levels, VL, and ocular manifestations in children with HIV. CD4 levels are an important indicator of the immune system, and VL is a measure of the amount of virus in the blood. Understanding the relationship between these factors can help develop a better handling strategy for children with HIV and reduce the number of pain and improve their quality of life.

Methodology

This study was conducted using a cross-sectional method, involving 25 positive HIV children in the Medan Plus Foundation in December 2023. Data collection was carried out through interviews, anterior and posterior segment examination, as well as a schirmer test, coupled with laboratory investigations from medical records in no more than 6 months ago. The study aimed to determine the relationship between CD4 levels and VL with ocular manifestations in children with HIV who receive ARV therapy.

Results

The results showed that of the 25 children studied, there were 14 boys (56%) and 11 girls (44%), with an average age of 11.64 years. Most children (88%) had a normal immune status, and the average duration of ARV therapy was 9.56 years, with 60% of children having undergone treatment for 5 to 10 years. The main complaints experienced by children related to the eye were blurred vision (24%), red and itchy eyes (16%), and watery eyes (4%). No children experienced dry eyes. For the anterior segment, conjunctivitis was found in 6%, blepharitis in 8%, and corneal scarring in 4%. In the posterior segment, tigroid fundus and nasalization were detected in 4%, and retinal detachment in 2%. The VL median value in children with ocular manifestations was 112 copies/ml, and the CD4 median level was 885.5 cells/mm³.

Discussion

The results of this study showed a statistically significant relationship between viral loads and ocular manifestations, while no relationship was found between CD4 levels and ocular manifestations. This suggests that other factors, such as viral loads, may play a role in determining the child's eye condition. Ocular manifestations in children with HIV can vary, ranging from mild conditions such as conjunctivitis to more severe conditions such as retinal detachment. This highlights the need for more intensive eye health monitoring in children infected with HIV, especially for those who have high viral loads.

Conclusion

This study provides an important insight into the impact of HIV on children's eye health. The results suggest that viral loads may play a significant role in determining the child's eye condition, while CD4 levels do not show a significant relationship with ocular manifestations. This study emphasizes the need for more intensive eye health monitoring in children infected with HIV, especially for those who have high viral loads. By understanding the relationship between CD4 levels, VL, and ocular manifestations, we can develop a better handling strategy for these children and try to reduce the number of pain and improve their quality of life.

Recommendations

Based on the findings of this study, the following recommendations are made:

Intensive eye health monitoring: Children infected with HIV should undergo regular eye health monitoring, especially for those who have high viral loads.
Education for parents: Medical personnel should provide education to parents about signs of eye problems in their children, so that early detection and proper treatment can be done.
Continued monitoring of side effects of treatment and disease manifestations: ARVs can help suppress viral loads and improve the quality of life of patients, but continued monitoring of side effects of treatment and disease manifestations is essential to improve the quality of life of children infected with HIV.
Development of a better handling strategy: By understanding the relationship between CD4 levels, VL, and ocular manifestations, we can develop a better handling strategy for children with HIV and try to reduce the number of pain and improve their quality of life.

Limitations

This study has several limitations, including:

Small sample size: The study involved a small sample size of 25 children, which may limit the generalizability of the findings.
Cross-sectional design: The study used a cross-sectional design, which may not capture the temporal relationship between CD4 levels, VL, and ocular manifestations.
Limited data collection: The study relied on data collection through interviews, anterior and posterior segment examination, as well as a schirmer test, which may not capture all the relevant information.

Future Directions

Future studies should aim to:

Investigate the temporal relationship between CD4 levels, VL, and ocular manifestations: A longitudinal study design can help capture the temporal relationship between these factors.
Increase the sample size: A larger sample size can help increase the generalizability of the findings.
Collect more comprehensive data: Future studies should collect more comprehensive data, including data on the child's medical history, family history, and socioeconomic status.
Frequently Asked Questions (FAQs) about the Relationship between Cluster Differentiation 4 (CD4) and Viral Load levels with Ocular Manifestations in Children with Human Immunodeficiency Virus (HIV) receiving Antiretroviral (ARV) Therapy

Q: What is the purpose of this study?

A: The purpose of this study is to investigate the relationship between cluster differentiation 4 (CD4) levels and viral load (VL) with ocular manifestations in children with Human Immunodeficiency Virus (HIV) who receive antiretroviral (ARV) therapy.

Q: What are the main findings of this study?

A: The study found a statistically significant relationship between viral loads and ocular manifestations, while no relationship was found between CD4 levels and ocular manifestations. The study also found that children with high viral loads were more likely to experience ocular manifestations.

Q: What are the implications of this study?

A: The study suggests that viral loads may play a significant role in determining the child's eye condition, while CD4 levels do not show a significant relationship with ocular manifestations. This highlights the need for more intensive eye health monitoring in children infected with HIV, especially for those who have high viral loads.

Q: What are the limitations of this study?

A: The study has several limitations, including a small sample size, a cross-sectional design, and limited data collection.

Q: What are the recommendations based on this study?

A: Based on the findings of this study, the following recommendations are made:

Intensive eye health monitoring: Children infected with HIV should undergo regular eye health monitoring, especially for those who have high viral loads.
Education for parents: Medical personnel should provide education to parents about signs of eye problems in their children, so that early detection and proper treatment can be done.
Continued monitoring of side effects of treatment and disease manifestations: ARVs can help suppress viral loads and improve the quality of life of patients, but continued monitoring of side effects of treatment and disease manifestations is essential to improve the quality of life of children infected with HIV.
Development of a better handling strategy: By understanding the relationship between CD4 levels, VL, and ocular manifestations, we can develop a better handling strategy for children with HIV and try to reduce the number of pain and improve their quality of life.

Q: What are the future directions for this study?

A: Future studies should aim to:

Investigate the temporal relationship between CD4 levels, VL, and ocular manifestations: A longitudinal study design can help capture the temporal relationship between these factors.
Increase the sample size: A larger sample size can help increase the generalizability of the findings.
Collect more comprehensive data: Future studies should collect more comprehensive data, including data on the child's medical history, family history, and socioeconomic status.

Q: What are the potential applications of this study?

A: The findings of this study can be applied in various settings, including:

Clinical practice: The study's findings can inform clinical practice and guide healthcare providers in managing children with HIV.
Public health policy: The study's findings can inform public health policy and guide decision-making about resource allocation and service delivery.
Research: The study's findings can inform future research and guide the development of new interventions and treatments for children with HIV.

Q: What are the potential limitations of applying the study's findings?

A: The study's findings may have limitations when applied in real-world settings, including:

Generalizability: The study's findings may not be generalizable to all children with HIV.
Contextual factors: The study's findings may be influenced by contextual factors, such as access to healthcare and socioeconomic status.
Complexity of HIV: HIV is a complex disease, and the study's findings may not capture all the nuances of the disease.