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Clinical correlation of CD4 count and dry eye disease (DED) severity among Human Immunodeficiency Virus (HIV) patients: A case study in Voluntary Counseling and Testing Clinic RSUP Prof Ngoerah, Bali


Introduction: Dry eye disease (DED) is a condition affecting the surface of the eye and the stability of tears, influenced by various factors. It has been documented as one of the most common ocular issues in the front segment among individuals with HIV, typically appearing in the later stages of the disease. The study sought to examine the clinical relationship between CD4 count and the severity of the condition.

Method: This study was conducted as a cross-sectional analysis within a hospital setting, involving 75 HIV-positive patients (140 eyes) aged between 18 and 50 years. These patients were referred to the ophthalmology clinic in the Voluntary Counseling and Testing (VCT) center due to complaints related to ocular surface issues, and they were enrolled in the study. All patients underwent a thorough ophthalmological assessment, including the completion of a dry eye questionnaire, specifically the Ocular Surface Disease Index (OSDI), and measurement of tear film break-up time (TBUT).

 Results: The research revealed a notable moderate positive correlation between CD4 count and TBUT (r=0.509; p=0.005), and a negative correlation with OSDI score (r=-0.252, p=0.035). Significant differences were observed in CD4 count between mild and moderate dry eyes (p=0.005) as well as between mild and severe dry eyes (p=0.005). No significant difference was found between moderate and severe dry eyes (p=0.435). The severity of dry eye in HIV patients appears to vary across different clinical stages of the disease, coinfection statuses, and treatment histories, although these differences did not reach statistical significance in the results.

 Conclusion: A correlation exists between CD4 count and the severity of dry eye disease among HIV patients. HIV patients with lower CD4 counts are at a higher risk of developing severe dry eye disease.


  1. Perdami. Pedoman Nasional Pelayanan Kedoteran (PNPK): Dry Eye. 2021.
  2. American Academy of Ophthalmology staff. External Disease and Cornea Basic and Clinical Science Course. San Fransisco: American Academy of Ophthalmology: 2022.
  3. Lee AJ, Lee J, Swa S-M, Gazzard G, Koh D, Widjaja D, Tan DTH. Prevalence and risk factors associated with dry eye symptoms: A population based study in Indonesia. British Journal of Ophthalmology. 2002;86(12):1347-51
  4. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276–83.
  5. Lemp MA, Foulks GN. The definition and classification of dry eye disease. Ocul Surf. 2007;5(2):75-92.
  6. Hashemi H, Khabazkhoob M, Kheirkhah A, Emamian MH, Mehravaran S, Shariati M, Fotouhi A. Prevalence of dry eye syndrome in an adult population. Clinical & experimental ophthalmology. 2014;42(3):242-8.
  7. Sahai A, Malik P. Dry eye: Prevalence and attributable risk factors in a hospital-based population. Indian journal of ophthalmology. 2005;53(2):87-91.
  8. Buckhold FR 3rd. Primary care of the human immunodeficiency virus patient. Med Clin North Am. 2015;99:1105–22.
  9. Gichuhi S, Arunga S. HIV and the eye. Community eye Heal. 2020;33(108):76–8.
  10. London NJ, Shukla D, Heiden D, Rathinam SR, Rathinam S, Arevalo JF, Cunningham ET. HIV/AIDS in the developing world. Int Ophthalmol Clin. 2020;50:201–18.
  11. Mathebula SD, Makunyane PS. Ocular surface disorder among HIV and AIDS patients using antiretroviral drugs. Afr Vision Eye Health. 2019;78:a457.
  12. Singalavanija T, Ausayakhun S, Tangmonkonvoragul C. Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study. PLoS ONE. 2019;13(2):e0193161.
  13. Acharya NR, Cunningham ET Jr. Corneal, anterior segment, and adnexal manifestations of human immunodeficiency virus. Int Ophthalmol Clin 1998;38:161–77.
  14. Gowda HTV, Krishnamurthy H, Tanushree V, Nayak S. Correlation of CD4 count and severity of dry eye in human immunodeficiency virus positive patients. Int J Sci Study. 2015;3(5):68–71.
  15. Sharma S, Rajput GC, Gupta D. Correlation of CD4 count and severity of dry eye in people living with HIV and AIDS (PLWHA). Himalayan Journal of Applied Medical Sciences and Research. 2021;5.
  16. Nguyen BN, Chung AW, Lopez E, Silvers J, Kent HE, Stephen J, et al. Meibomian gland dropout is associated with immunodeficiency at HIV diagnosis: implications for dry eye disease. Ocul Surf . 2020;18:206-13.
  17. Qian Y, Wu Z, Chen C, Du K, Wei W. Detection of HIV-1 viral load in tears of HIV/AIDS patients. Infection. 2020;48(6):929–33.

How to Cite

Wulansari, P. A. ., Juliari, I. G. A. M. ., & Pramita, I. A. A. . (2024). Clinical correlation of CD4 count and dry eye disease (DED) severity among Human Immunodeficiency Virus (HIV) patients: A case study in Voluntary Counseling and Testing Clinic RSUP Prof Ngoerah, Bali . Intisari Sains Medis, 15(1), 372–377.




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