Ocular involvement in AIDS

Ocular pathology in acquired immunodeficiency syndrome

Gross and microscopic ocular findings were prospectively studied in 38 human immunodeficiency virus (HIV)-seropositive subjects undergoing postmortem examination. Pathologic lesions were detected in 27 patients (71%), with 67% of the abnormal findings detected only microscopically.

Ocular findings in HIV-1 positive and HIV-1 negative participants in a rural population-based cohort in Uganda

PURPOSE

To report the ocular findings in HIV-1 seropositive individuals and HIV-negative controls in a population-based cohort in rural Uganda.

METHODS

Participants were examined by an ophthalmologist, who was unaware of their HIV-status.

RESULTS

238 participants were examined, 43 were HIV-1 prevalent cases (infected prior to 1990); 62 were HIV-1 incident cases and 133 were HIV-negative controls. Eleven of the HIV-positive participants had AIDS, and a further 8 had a CD4 count of less than 200 cells/mm3. Bilateral low vision was recorded in 9 participants and cataracts were the main cause of bilateral low vision. The mean intra-ocular pressure (IOP) was 12.6 mm Hg, and no association was found between IOP and CD4 lymphocyte count. Although significantly more HIV positives had some sign of intraocular inflammation compared to the negatives (p = 0.02) there was no significant linear trend in the HIV positives with decreasing CD4 count. Overall, 11 (26%) prevalent, 6 (10%) incident cases and 8 (6%) HIV-negatives controls had some evidence of intraocular inflammation, however, only one person had reduced visual acuity attributable to these lesions. Punctate epithelial erosions and keratic precipitates in the anterior chamber were seen significantly more frequently in HIV-positives compared to the HIV-negative controls. Cotton wool spots were not seen.

CONCLUSIONS

A substantial proportion of HIV-infected persons had ocular findings which may have been attributable to their infection, however in only one case did this result in reduced visual acuity. Although the ocular complications of AIDS seem to comprise a large extra element in the work load of tertiary care hospitals dealing with eye problems, on a population basis such cases are infrequent.

AIDS and the eyes

The eye is affected in 50-75% of adult AIDS patients. This rate of ocular involvement is much higher than that in symptom-free HIV-seropositive patients, and seems to increase in incidence with severity of disease. These observations indicate that regular screening of HIV-positive patients is warranted to allow early identification of potential vision and life threatening disease.

Ophthalmic disease in patients with unrecognized HIV infection

HIV disease has a long and relatively asymptomatic incubation period before the onset of AIDS. The ophthalmic manifestations of AIDS are well recognized. Little is known of the incidence or range of ophthalmic disease seen in the latent period of HIV disease. A retrospective analysis of 125 case notes of HIV 1 antibody positive patients was undertaken. Of these, 15 (12%) had previously attended the ophthalmic department, at which stage their HIV status was unknown. Eight patients were diagnosed as being HIV positive within twelve months of attending the ophthalmic department. There was a predominance of ophthalmic infections, as opposed to trauma which is the commonest cause for ophthalmic casualty referral. Some of the ophthalmic presentations seen were the initial presenting sign of HIV disease. There were also cases of serious trauma and a mixture of other ophthalmic diseases. We discuss these ophthalmic findings and their relevance to HIV disease.

Cytomegalovirus retinopathy and the acquired immune deficiency syndrome: results of treatment with ganciclovir

Cytomegalovirus (CMV) infection of the retina is the commonest potentially blinding ocular manifestation of AIDS. Recently the acyclic nucleoside dihydroxypropoxymethyl guanine (DHPG, ganciclovir) has become available to treat sight-threatening CMV retinopathy. This paper reports the clinical features and results of ganciclovir therapy in 48 patients seen over a four-year period. Seven patients were excluded from the study due to inadequate follow-up, leaving 41 patients as the study group. All patients responded clinically to this therapy. Patients were treated initially with high-dose ganciclovir (10 mg/kg/day) and then continued on lower dose treatment (5 mg/kg/day) indefinitely. Significant bone marrow toxicity developed in 12 patients (29.3%) requiring temporary cessation of therapy. Patients treated with ganciclovir retained vision and had increased survival times when compared to untreated patients. A poor visual outcome occurred when there was involvement of the macula or optic nerve head at presentation or when there was an interruption of ganciclovir therapy.

Syphilitic retinitis in a homosexual man with concurrent HIV infection: case report

A case is reported of secondary syphilis with ocular signs in a patient who had antibodies to human immunodeficiency virus (HIV) and hepatitis B infections and from whose urine cytomegalovirus was cultivated. Treatment with penicillin resulted in rapid recovery from his retinitis and uveitis. The case highlights the importance of testing for syphilis in all patients with HIV infection.