Comparative study of ocular manifestations of HIV infection at a tertiary care hospital in Maharashtra, India
Abstract
Purpose: We conducted the study to observe the change in infection patterns with the introduction of highly active antiretroviral therapy (HAART) and correlation of CD4 count with various ocular manifestations of acquired immune deficiency syndrome (AIDS).
Design: This was a prospective observational cohort study.
Methods: The study was conducted at a tertiary care teaching institute with established antiretroviral therapy (ART) centre. A total of 240 eyes of 120 ART-naive patients were enrolled. Ocular manifestations of these patients were observed and followed up for six months for any change with HAART.
Results: Out of 240 eyes, 24 showed ocular involvement (10%), of which human immunodeficiency virus (HIV) microangiopathy and molluscum contagiosum were most common. Out of the four cases of HIV microangiopathy, two cases demonstrated complete resolution after six months of ART. Only one of three cases of cytomegalovirus (CMV) retinitis showed healing after six months of ART.
Conclusions: Vision-threatening CMV retinitis and herpes zoster ophthalmicus can improve if specific treatment is initiated promptly. There is direct correlation between CD4 count, ocular manifestation, and prognosis of the patients; 33.33% of patients showed improvement in ophthalmic manifestations after HAART during a follow-up period of 6 months.
References
Annual report 2015-2016, National AIDS Control Organization.
Jabs DA. Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc. 1995;93:623-683.
Conway MD, Tong P, Olk RJ. Branch retinal artery occlusion (BRAO) combined with branch retinal vein occlusion (BRVO) and optic disc neovascularization associated with HIV and CMV retinitis. Int Ophthalmol. 1996;19:249-252.
Friedman SM, Margo CE. Bilateral central retinal vein occlusions in a patient with acquired immunodeficiency syndrome: Clinico-pathologic correlations. Arch Ophthalmol. 1995;113:1184-1188.
Biswas J, Madhavan HN, George AE, Kumarasamy N, Solomon S. Ocular lesions associated with HIV infection in India: a series of 100 consecutive patients evaluated at a referral center. Am J Ophthalmol. 2000;129:9-15.
Cunningham ET, Margolis TP. Ocular manifestations of HIV infection. N Engl J Med. 1998;339:236-244.
Hodge WG, Seif SR, Margolis TP. Ocular opportunistic infection incidences among patients who are HIV positive compared to patients who are HIV negative. Ophthalmology. 1998;105:895-900.
Ali R, Kim JY, Henderson BA. Adnexal and anterior segment manifestations of HIV-AIDS. Int Ophthalmol Clin. 2007;47:15-32.
Meyer D. Eye signs that alert the clinician to a diagnosis of AIDS. SADJ. 2005;60:386-387.
Kahraman G, Krepler K, Franz C, et al. Seven years of ART impact on ophthalmic management of HIV-infected patients. Ocul Immunol Inflamm. 2005;13:213-218.
Zaal MJ, Volker-Dieben HJ, Wienesen M, D’Amaro J, Kijlstra A. Longitudinal analysis of varicellazoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus. Am J Ophthalmol. 2001;131:25-29.
Mesaric B, Lisic M, Kniewald T, Ugrinovic N, Begovac J. Ocular manifestations in patients with human immunodeficiency virus infection before and after the introduction of highly active antiretroviral therapy. Lijec Vjesn. 2005;127:123-128.
Arruda RF, Muccioli C, Belfort R Jr. Ophthalmological findings in HIV infected patients in the post-ART (Highly Active Anti-retroviral Therapy) era, compared to the pre-ART era. Rev Assoc Med Bras. 2004;50:148-152.
Sudharshan S, Kaleemunnisha S, Banu AA, et al. Ocular lesions in 1,000 consecutive HIV-positive patients in India: a long-term study. J Ophthalmic Inflamm Infect. 2013;3:2.
Pathai S, Deshpande A, Gilbert C, Lawn SD. Prevalence of HIV-associated ophthalmic disease among patients enrolling for antiretroviral treatment in India: a cross-sectional Study. BMC Infect Dis. 2009;9:158.
Copyright (c) 2019 Sanjeevani Ambekar, Dhiraj Badale, Dileep Kadam, Sonali Salvi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication, with the work twelve (12) months after publication simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
