CD4 counts: a strong indicator of retinal and ocular lesions in HIV disease

Clinical Profile of Patients on Highly Active Antiretroviral Therapy (HAART) Seen in a Tertiary Eye Clinic

Background

Highly active antiretroviral therapy (HAART) is the medication regimen for the management of human immunodeficiency virus. Over time, it has been dubbed to have revolutionised the clinical course and outcomes of HIV/AIDS.

Objective

The objective of this study is to determine the clinical factors associated with the ocular manifestation of HIV/AIDS among patients on HAART.

Materials and Methods

This was a descriptive cross-sectional study conducted at the ophthalmology department of the University of Nigeria Teaching Hospital (UNTH) in 2017 among adult patients (≥18 years) attending the hospital's antiretroviral therapy (ART) clinic and selected using systematic random sampling technique. Statistical Package for Social Sciences (SPSS) version 21 was used for data analysis, with variables being summarised using frequencies and proportions. Inferential statistics (t test, Chi-square test, and Fisher's exact test) was used to test associations between variables. A level of significance was set at a P value of less than 0.05 corresponding to a 95% confidence interval.

Results

A majority of patients were in WHO stages 1 and 2 of HIV and the mean CD4+ cell count of the whole population was 575.0 ± 512.56 cells/µL, while that of those with ocular manifestations was 315.2 ± 290.76 and 633.7 ± 533.54 cells/µL for those who do not have ocular manifestation. There was a significant association between CD4+ cell count and ocular manifestations such as conjunctival microvasculopathy, anterior uveitis, and cytomegalovirus retinitis.

Conclusion

Our results suggest that HAART has some positive effect on the clinical profile of people with HIV/AIDS with CD4+ count being a major determinant of ocular manifestations.

Ocular manifestations in HIV patients attending a tertiary care hospital in Eastern India and correlation of posterior segment lesions with CD4+ counts

PURPOSE

We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts.

METHODS

This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case.

RESULTS

A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30-39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001).

CONCLUSION

Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections.

Ocular manifestations in patients attending antiretroviral therapy centre at a tertiary care hospital in Himachal Pradesh, India

Background & objectives:

Ocular manifestations in HIV/AIDS patients range from adnexal disorders to the posterior segment disease. This study was aimed to evaluate the ocular manifestations, including vision-threatening manifestations in HIV-positive patients attending an antiretroviral therapy centre (ART) of a tertiary care hospital in north India and its association with the CD4+ cell count.

Methods:

This cross-sectional study was conducted in the department of Ophthalmology in collaboration with the ART centre. An equal number of patients were selected from each year i.e., 30 patients each from those registered in the year 2010 till 2015. These patients were selected randomly from the register using systematic randomization. Hence, a total of 150 patients were examined for ocular manifestations. All the patients included in this study were on highly active ART.

Results:

Of the 150 patients examined, 53 per cent were females and 47 per cent were males. Heterosexual transmission was the most common mode of transmission in 126 (84%) patients. Maximum number of patients was in the age group of 31-40 yr. Ocular manifestations were present in 53 [35.3%; 95% confidence interval (CI): 28-43%] patients. Twelve (8%; 95% CI: 4-12%) patients had lid and adnexal manifestations. Anterior-segment manifestations were present in 20 (13.3%; 95% CI: 8-19%) patients. Posterior-segment manifestations were present in 21 (14%; 95% CI: 8-20%) and vision-threatening posterior-segment ocular lesions were present in 14 per cent of the patients. Univariate logistic regression showed a significant (P <0.001) inverse association of CD4+T-cell count with the vision-threatening posterior-segment ocular lesions.

Interpretation & conclusions:

Routine ocular examination may be done in all the HIV/AIDS patients to detect and treat vision-threatening ocular lesions at the earliest.

Ophthalmic Manifestations of HIV Patients in a Rural Area of Western Maharashtra, India

Introduction. HIV/AIDS is one of twenty first century's biggest global challenges to mankind with protean manifestations affecting all organs of our body, not even sparing the eyes. The purpose of this study was to determine the pattern of ocular manifestations of HIV/AIDS and their correlation with CD4-count in a rural area of India. Methods. A hospital based observational cross-sectional study was done on 40 HIV-positive patients presenting to ART center with ocular complaints. Data were collected using face-to-face interview, clinical examination, slit lamp examination, fundus examination, and laboratory investigations. Results. Out of 40 patients, 21 were males and 19 were females with mean age of 38.75 ± 13.9 years. HIV retinopathy was the most common HIV-associated ophthalmic lesion while anterior uveitis was the most common anterior segment finding. Posterior segment lesions showed significant association (P < 0.05) with low CD4-count of the patient. CMV retinitis, retinal detachment, tubercular chorioretinitis, and acute retinal necrosis were all seen in patients with CD4-count less than 100 cells/mm³. Conclusions. HIV retinopathy, CMV retinitis, herpes zoster ophthalmicus, and anterior uveitis are common ocular manifestations associated with HIV infection. Low CD4-count is a risk as well as predictor for ocular manifestations. There needs to be awareness of ocular involvement among HIV infected individuals and an increased emphasis on regular ophthalmic examination.