Ophthalmic complications of HIV infection

AIDS Presenting in an Adolescent Male With Persistent Conjunctivitis and Eye Pain

An adolescent male with persistent conjunctivitis and an episcleral nodule presented with new-onset focal seizures and headaches. The patient was found to have cotton wool spots and papilledema on retinal examination. He was ultimately diagnosed with HIV retinopathy and AIDS. Ocular manifestations are rare presenting symptoms of AIDS among adolescents in the United States. Ocular disease in pediatric HIV/AIDS patients is most often caused by opportunistic infections. HIV retinopathy, the most common cause of blindness in patients with HIV, is usually a late disease manifestation. It is important for providers caring for adolescents to be aware of the potential ocular manifestations of HIV/AIDS. Teenagers are less likely to be aware of their HIV status and less likely to be tested for HIV, despite high risk exposures, and therefore, universal and routine HIV screening is recommended for all patients.

Ocular manifestations of acquired immunodeficiency syndrome in Korea

The clinical features of HIV/AIDS-related ocular manifestations in Korean patients were investigated in this study. Data on 200 consecutive Korean patients diagnosed with AIDS who visited the Seoul National University Hospital from January 2003 to June 2008 were reviewed. Fifty-seven patients (28.5%) had ocular manifestations, and they showed significantly lower CD4+ T cell count than patients without ocular manifestations. Among them, 23 (40.3%) patients showed retinal microvasculopathy, and 22 (38.5%) patients showed cytomegalovirus (CMV) retinitis. Other manifestations included retinal vein occlusion (n = 4), herpes zoster ophthalmicus (n = 4), syphilitic uveitis (n = 2), acute retinal necrosis (n = 1), and progressive outer retinal necrosis (n = 1). The mean CD4+ lymphocyte counts of the patients with retinal microvasculopathy and cytomegalovirus retinitis were 108.5 cells/µL and 69.4 cells/µL, respectively. In conclusion, ocular manifestations including CMV retinitis are common complications in Korean patients with AIDS even in the era of highly active anti-retroviral therapy. Compared to previous reports in western countries, prevalence of CMV retinitis is relatively low and CD4+ lymphocytes count at the time of diagnosis is relatively high.

Human Eye Infections

The eye contains a variety of cell and tissue types. Conjunctivitis due to respiratory RNA viruses represents by far the most common viral eye disorder. However, any ocular tissue can sustain infection by human viruses, including those viruses with predilection for neural sites. As elsewhere in the body, ocular pathologic changes induced by viruses tend to follow stereotypical patterns. Classical viral mechanisms of infection, including latency, reactivation, and carcinogenesis, can all be demonstrated in the eye. The eye's tissues also demonstrate a wide variety of immune responses, including those of mucosa-associated lymphoid tissue and immune privilege. The ocular complications of AIDS, including viral retinitis and ocular surface squamous carcinoma, remain significant causes of morbidity throughout the world.

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

BACKGROUND: Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses. METHODS: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm³ for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients. RESULTS: From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed. CONCLUSION: CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.