Hubungan Kadar Hormon Leptin dengan Kadar Cluster of Differentiation 4 (CD4) pada Pasien Human Immunodeficiency Virus (HIV) yang Mendapatkan Terapi Antiretroviral (ARV)

Abstract

Introduction: Leptin is a hormone secreted by adipocytes that regulates food intake through central neuroendocrine mechanism. Leptin also plays a role in immunity responses, specifically T lymphocyte, as it increases the number and function of T cells. Leptin deficiency results in an immunodeficiency state due to a reduction in the total number of T cells, CD4+ Th cells, and a change in dominance from Th1 to Th2 cells. Previous studies have shown that in HIV patients receiving HAART, there is a decreased leptin levels due to decreased amounts of fat in adipose tissue which correlate with immune status of the patients although the results are inconsistent. This study aims to assess the relationship of leptin levels and CD4 count in HIV patients receiving HAART. Method: This is a cross sectional study conducted at the outpatient clinic of Tropical and Infectious Disease Haji Adam Malik General Hospital Medan between April and July 2020 with the approval of the USU Faculty of Medicine Research Ethics Commission. Correlation between variables were assessed through Pearson’s or Spearman’s correlations. Data were analyzed using the SPPS program where p <0.05 was considered significant. Results: Of the 40 subjects, the majority were male (70%), senior high school student (77.5%), married (57.5%) and the mean age was 35.07 ± 6.2 years. HIV stage III was the most prevalent stage (87.5%), the fixed drug combination mostly prescibed was Tenofovir, Lamivudin, Efavirenz regimen (87.5%) and the mean duration of treatment was 2.48 ± 2.261 years. The average leptin level was 1071.47 ± 924.21 and the average CD4 count was 330.55 ± 163.98. Leptin levels were significantly correlated with CD4 count (r = 0.351, p = 0.026) and nutritional status (Body Mass Index: r = 0.420, p = 0.007; Waist Circumference: r = 0.321, p = 0.043; Albumin Level: r = 0.412, p = 0.008). Conclusion: There is a significant relationship between leptin levels and CD4 count in HIV patients receiving HAART.

Pendahuluan: Leptin merupakan hormon yang disekresi sel adiposit dan berperan mengatur asupan makanan melalui mekanisme neuroendokrin sentral. Leptin juga berperan dalam respon imun, terutama sel limfosit T, dengan meningkatkan jumlah dan fungsi sel T. Defisiensi hormon leptin akan menyebabkan penurunan imunitas akibat berkurangnya jumlah sel T, sel Th CD4+, dan perubahan dominasi dari sel Th1 ke Th2. Beberapa penelitian sebelumnya telah menunjukkan bahwa kadar leptin menurun pada pasien HIV yang mendapatkan terapi ARV akibat penurunan jumlah lemak di jaringan adiposa dimana hal ini berkorelasi dengan status kekebalan pasien namun hasil berbagai penelitian ini tidak konsisten. Penelitian ini bertujuan untuk menilai hubungan kadar leptin dengan kadar CD4 pada pasien HIV yang mendapatkan terapi ARV. Metode: Penelitian ini merupakan penelitian cross-sectional di Poliklinik Penyakit Tropis dan Infeksi RSUP Haji Adam Malik Medan dari bulan April-Juli 2020 dan telah mendapat persetujuan Komisi Etik Penelitian FK USU. Hubungan antar variabel dianalisis menggunakan korelasi Pearson atau Spearman. Data dianalisis dengan menggunakan program SPPS di mana p < 0,05 dianggap signifikan. Hasil: Dari 40 subjek penelitian, mayoritas berjenis kelamin laki-laki (70%), dengan tingkat pendidikan terbanyak SMA (77,5%), menikah (57,5%) dan rerata usia 35,07 ± 6,2 tahun. Stadium HIV terbanyak adalah stadium III (87,5%), mayoritas mendapatkan pengobatan ARV dengan regimen Tenofovir, Lamivudin, Efavirenz (87,5%) dan rerata durasi pengobatan adalah 2,48 ± 2,261 tahun. Rerata kadar leptin subjek 1071,47 ± 924,21 dan rerata kadar CD4 330,55 ± 163,98. Penelitian ini menunjukkan bahwa terdapat hubungan signifikan antara kadar leptin dengan kadar CD4 (r = 0,351, p = 0,026) dan status nutrisi subjek (IMT: r = 0,420, p = 0,007; Lingkar Pinggang: r = 0,321, p = 0,043; Kadar Albumin: r = 0,412, p = 0,008). Kesimpulan: Terdapat korelasi yang signifikan antara kadar leptin dengan kadar CD4 pada pasien HIV yang mendapatkan terapi antiretroviral.