Hubungan Antara Kadar CD4 dengan Gambaran Ensefalitis Toxoplasmosis dari CT Scan Kepala Non Kontras ada Pasien HIV di RSUP Haji Adam Malik Medan Tahun 2021-2022

Abstract

Background: HIV/AIDS can reactivate Toxoplasma gondii infection due to weakened immunity. Toxoplasmosis is an infection caused by the intracellular protozoan Toxoplasma gondii. About 30% of the world's population tests positive for Toxoplasma gondii antibodies. Opportunistic infections may employ head CT scans without contrast as a supportive examination to monitor therapy, including for cerebral toxoplasmosis. Head CT scan screening for HIV patients with headache complaints revealed abnormal images in those with CD4 levels below 200. Objective: Understanding the correlation between CD4 counts and presentations of toxoplasmosis encephalitis on non-contrast head CT scans in HIV patients at Haji Adam Malik Hospital Medan during 2021-2022. Subjects and Methods: This is an analytical study that utilizes a cross-sectional design to establish a correlation between CD4 levels and toxoplasmosis encephalitis images derived from non-contrast head CT scans of HIV patients at Haji Adam Malik Medan General Hospital from 2021-2022 as seen in medical records analyzed by researchers along with a radiologist. Results: The study revealed that male participants accounted for 66.7% of the total, whereas female participants accounted for 33.3%. The average age of the participants was 36.43 years, ranging from 18 years as the youngest to 76 years as the oldest. Among HIV-infected patients with Toxoplasmosis Encephalitis, common clinical symptoms were headache, reported by 53.3% of patients, and decreased consciousness, reported by 36.7% of patients. Additionally, patients exhibited other neurological symptoms and signs, such as seizures and limb weaknesses. There is a significant correlation between CD4 cell levels and lesion location in various lobes (frontal, occipital, temporal, parietal) (p=0.018). Additionally, there is a significant association between lesions with perifocal edema type and CD4 levels (p=0.034). According to this study, HIV patients with CD4 cell levels less than 200 cells/mm had a higher incidence of Toxoplasma Encephalitis with perifocal edema images on non-contrast head CT scans. Specifically, 18 out of 30 patients (60%) had this outcome. Conclusion: There is a significant correlation between CD4 cell counts and Toxoplasmosis Encephalitis imaging findings on non-contrast CT scans in patients with HIV at Haji Adam Malik Hospital in Medan.