A study of sexually transmitted infections among HIV – infected patients in correlation with their CD4 T cell counts

A B S T R A C T Context: Sexually transmitted infections is most common infectious disease for public health. Human immunodeﬁciency virus (HIV) alters the clinical presentation of sexually transmitted infections, their natural history, relative prevalence and response to treatment. Aims: To study the sexually transmitted infections and their correlation with the CD4 T cell counts among HIV – infected patients. Settings and Design: Department of dermatology, venereology and leprology, tertiary care hospital, Cross-sectional study. Methods and Material: A total of one hundred and ﬁfty-ﬁve cases of HIV seropositivity were studied over a period of twelve months. A detailed history covering all relevant points was recorded in all cases. Each patient underwent a thorough general, physical, systemic, dermatological and venereological examination. Twenty-ﬁve out of one hundred ﬁfty-ﬁve cases had sexually transmitted infections. All relevant investigations were done and data was recorded. Statistical analysis used: Data analysis was done using Statistical Package for Social Sciences (SPSS) v.21 for windows and Chi-square test was used. Results: Out of the twenty-ﬁve patients, nineteen were males, ﬁve females and one transgender. Maximum numbers of patients were between the age group of 31-40 years. Most common sexually transmitted infection was herpes progenitalis (64%). Others were genital warts (16%), balanoposthtitis (8%), gonorrhea (4%), syphilis (4%), buschke-lowenstein tumour (4%) and genital molluscum contagiosum (4%). Conclusions: There is a strong association between the occurrence of HIV and the presence of sexually transmitted infections. Key Message: Both HIV and sexually transmitted diseases are closely interlinked. So, early diagnosis, treatment and control of sexually transmitted diseases offer a rational approach to the management. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license (https://


Introduction
The objective of the present study is to find out association of HIV infection with various sexually transmitted infections and correlate with their CD4 T cell counts.
STDs have remained a health issue since many centuries; they became a major health problem worldwide by the appearance of HIV around 1980. The relationship between sexually transmitted infections and HIV is complex. 2013 to January 2014. A detailed history of each case was taken. An attempt was made to know the possible mode of transmission of HIV infection in each patient and/or a history of any risk factor(s) in the spouse. A thorough clinical examination, which included the general examination followed by a detailed dermatological evaluation with emphasis on sexually transmitted infections, was done and findings were recorded. The clinical diagnosis of genital lesions was supplemented with relevant laboratory investigations such as gram staining ,10% KOH mount under the microscope, tzanck smear, venereal disease research laboratory test (VDRL), skin biopsy in selected cases. Patients were treated according to diagnosis made. Specific treatment was given for sexually transmitted infections. Cases were asked to come for follow-up every week initially, and monthly after clinical cure.
Data analysis was done using Statistical Package for Social Sciences (SPSS) v.21 for windows. For comparison of frequencies and percentages Pearson Chi-square test was used. For comparison of more than two groups Krushal Wallis test was used. P value <0.05 was considered statistically significant.

Results
One hundred and fifty-five cases were observed over a period of one year. Twenty-five cases (16.12%) had sexually transmitted infections (n = 25, one patient had both herpes progenitalis and genital warts). Out of these nineteen (76%) were males, five (20%) were females and one (4%) transgender. Maximum cases (48%) were in the age group of 31-40 years. A total of sixteen (64%) patients were married, six (24%) unmarried, two (8%) were separated and one (4%) widowed. Most common route of transmission was found to be heterosexual (76%) [ Table 1] and most common infection was herpes progenitalis (64%) [ Figure. 1] with a mean CD4 T cell count of 289.81 cells/cumm, [

Discussion
In the present study, males comprised of 76% whereas females comprised of 20% of the patients with 4% being transgender. This was similar to a study done by Agrawal et al. 3 which had 72.1% males and 27.9% females. The highest incidence of HIV positive patients is in the age group of 21-40 years (65.16%) which highlights the fact that it is most common in sexually active age group which makes them most vulnerable similar results were reported in other studies. [4][5][6][7][8][9] Maximum patients were from a rural background and mainly were illiterate. This causes lack of awareness about the safe sexual practices, making them more prone to develop sexually transmitted infections and HIV. 64% patients were married which signifies the polygamous relationship in these patients making them

Conclusion
HIV-related sexually transmitted infections are quite common and present according to the degree of immunosuppression. They can be easily detected if studied properly and can also serve as diagnostic and prognostic markers. The present study also highlights the need for modest interventions -moral and health education to prevent HIV infection and sexually transmitted infections in younger age group.

Source of Funding
None.

Conflict of Interest
None.