Low CD4 Level Increased the Risk of Cognitive Impairment in the HIV Patient

Background: HIV infection leads to neurological damage that results in cognitive and behavioural impairment called HIV-associated neurocognitive disorder (HAND). There are several factors associated with HAND which include the CD4 count. Patients who present with the CD4 level lower than 200 cells/mm³ are considered very vulnerable of experiencing neurological complications such as HAND.

Objective: To investigate the association between CD4 level and cognitive impairment evaluated using MoCA-INA among HIV patients.

Materials and Method: This cross-sectional study involves 72 consecutive patients with HIV (Human Immunodeficiency Virus) infection from the Infecion Ward of Soetomo General Hospital Indonesia. All participating patients was measured its cognitive impairment through MoCA-INA score. Blood samples were collected for CD4 evaluation. Statistics were evaluated with SPSS 25.0.

Results: The research participant consisted of 43 (59.7%) male and 29 (40.3%) female with mean age of 38.22 ± 9.159, CD4 level of 447.4 ± 247.48 and MoCA-INA score of 26.36 ± 2.770. Chi-Square analysis showed a significant difference (p-value of 0.023) in the cognitive function in the HIV patient with low CD4 (CD4<200cell/mm³) compared tonormal CD4 (CD4≥200 cell/mm³) with Odd Ratio of 4.900 (95% CI, 1.278–18.793).

Conclusions: Low CD4 level increase the risk of cognitive impairment assessed using MoCA-INA scoring system. These suggested that HIV patient with low CD4 should have initial screening of cognitive impairment.