MEASURE ANALYSIS IgA SALIVA AND NUMBER OF CD4 T CELL IS ASSOCIATED WITH HIV-LESI PERIODONTAL BACTERIA SPIROCHAETA AND NUMBER IN THE ERA OF HAART (Study in Pokdisus AIDS Cipto Mangunkusumo General Hospital Jakarta)

Sufiawati, Irna. THESIS. Faculty of Medicine University of Indonesia. Jakarta 2007

Background
HIV infection appears to have direct effects on oral mucosal immunity, cellular and humoral. antibody secretion, especially salivary immunoglobulin A (IgA), is a useful indicator of mucosal immune function. This immune system component is recognized as an important arst line of defense against pathogens which colonize and invade mucosal surfaces in the oral cavity. Depletion of CD4+ T cell counts and abnormality of salivary IgA levels have been shown to associate with incidence and progression of HIV periodontal lesion. The severe immunosuppression seems to favor the colonization and overgrowth of pathogenic microbial dental plaque, including the spirochetes. The spirochetes are often the dominant bacterial types observed in subgingival plaque removed from diseased periodontal sites, such as necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative periodontitis (NUP).

Objectives
The aim of this study was to investigate salivary IgA levels and CD4+ T cell counts among HIV/AIDS patients in Pokdisus AIDS Dr. Cipto Mangunkusumo Hospital Jakarta, and their association with HIV periodontal lesions and the spirochetes counts in the HAART era.

Methods
The design study was using a cross sectional study. Whole paraffin wax stimulated Saliva was collected from 103 HIV infected patients and 30 healthy individuals. Saliva was collected using the spitting method. Salivary IgA levels were determined by the immunoturbidimetry method using the Behring Turbitimer Analyser. Subjective and objective examination was done to explored HIV periodontal lesions. A direct slide preparation of the Sub gingival plaque was done to examine the spirochetes counts and it is obtained by the use of microscope using a simple quantitative enumeration system.

Results
Salivary IgA levels were 141.55 ± 83.23 (HIV group) and 97.24 ± 38.25 (healthy individuals). The Mann Whitney U test showed salivary IgA levels were significantly higher Ln HIV/AIDS subjects compared with healthy individuals (p<0.1). Most of the subject have severe immunosuppresion with CD4+ T cell counts 0.1). The prevalence of HIV periodontal lesions was 2.9%. Association between CD4+ T cell counts and salivary IgA levels with HIV periodontal lesions has not been proven vet. Most of the subject was found with fewer spirochetes counts. The Spearman’s correlation test showed no significant correlation between the spirochetes counts with CD4+ T cell counts, r=0.085, p>O. 1) and salivary IgA levels (r=O. 117, p>O. 1). The Kendall’s rank correlation test showed statistically significant correlation between salivary IgA levels with salivary flow rate, oral hygiene, smoking, and ARV (W=0.736, p<0.1), and between the spirochetes counts with oral hygiene, smoking, and ARV (W=0.639, p<O. 1).

Conclusions
Our study indicates that salivary IgA levels were significantly higher in the HIV/AIDS subjects compared to healthy individuals, and salivary IgA levels seem not to be related to CD4+ T cell counts. This study has not proved the association between salivary IgA levels and CD4+ T cell counts with HIV periodontal lesions and the spirochetes counts, however salivary IgA levels and the spirochetes counts showed a statistically significant correlation with the risk factors.

Key words: Salivary IgA, CD4+ T cell, HIV periodontal lesion, spirochetes.

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