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Bibb LA, Htet KZ, Waldman CW, Sloan SB. Sexually transmitted infections and HIV in ophthalmology. Clin Dermatol 2024; 42:25-37. [PMID: 37582453 DOI: 10.1016/j.clindermatol.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
The ocular and periocular manifestations of sexually transmitted infections are heterogeneous in etiology, manifestations, and complications. Etiologic agents include bacteria, viruses, parasites, and protozoa, which are most frequently transmitted via direct ocular contact with an active lesion or infected bodily fluid, autoinoculation, or dissemination from a distant site. Vertical transmission most commonly occurs perinatally during vaginal delivery. The complications of ophthalmia neonatorum can be severe, with the potential for permanent blindness or life-threatening systemic involvement if untreated. Clinical features, diagnostic modalities, and therapeutic regimens vary based on etiology and are summarized in this review. Prompt diagnosis is imperative, given the severe sequelae that may result from ocular involvement in these infections, including permanent vision loss. A multidisciplinary approach, involving both ophthalmology and dermatology, to diagnosis and management is essential to mitigate the risk of morbidity associated with sexually transmitted infections resulting in eye disease.
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Affiliation(s)
- Lorin A Bibb
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Kyaw Zin Htet
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Corey W Waldman
- Department of Ophthalmology, University of Texas at San Antonio School of Medicine, San Antonio, Texas, USA
| | - Steven Brett Sloan
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Papathanassiou M, Zampeli E, Mehta JS, Theodossiadis P. Unusual case of silent corneal perforation in a human immunodeficiency virus‐infected patient. Clin Exp Optom 2021; 94:589-91. [DOI: 10.1111/j.1444-0938.2011.00613.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Jodhibir S Mehta
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore. E‐mail:
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Qian Y, Che X, Jiang J, Wang Z. Mechanisms of Blood-Retinal Barrier Disruption by HIV-1. Curr HIV Res 2020; 17:26-32. [PMID: 30873925 DOI: 10.2174/1570162x17666190315163514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 11/22/2022]
Abstract
It has been found that human immunodeficiency virus (HIV)-1 RNA or antigens can be detected in the intraocular tissues of HIV-1 patients even under effective highly active anti-retroviral therapy (HAART). In vivo, blood-retinal barrier (BRB) establishes a critical, physiological guardian against microbial invasion of the eye, but may be compromised in the presence of HIV-1. The envelope glycoprotein gp120 is exposed on the surface of the HIV envelope, essential for virus entry into cells by the attachment to specific cell surface receptors. The BRB disruption by glycoprotein gp120 has been widely recognized, which is toxic to human retinal epithelial cells (RPE) and umbilical vein endothelial cells (HUVEC). The present review elaborates on various mechanisms of BRB disruption induced by HIV gp120, which may represent potential targets for the prevention of ocular HIV complications in the future.
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Affiliation(s)
- Yiwen Qian
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
| | - Xin Che
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
| | - Jing Jiang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
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Powell CA, Carbo AR. The Great Imitator: Visual Changes in a 37-Year-Old Man with HIV. Am J Med 2018; 131:e19-e20. [PMID: 28807708 DOI: 10.1016/j.amjmed.2017.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | - Alexander R Carbo
- Harvard Medical School, Boston, Mass; Hospital Medicine Program, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
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Qian YW, Li C, Jiang AP, Ge S, Gu P, Fan X, Li TS, Jin X, Wang JH, Wang ZL. HIV-1 gp120 Glycoprotein Interacting with Dendritic Cell-specific Intercellular Adhesion Molecule 3-grabbing Non-integrin (DC-SIGN) Down-Regulates Tight Junction Proteins to Disrupt the Blood Retinal Barrier and Increase Its Permeability. J Biol Chem 2016; 291:22977-22987. [PMID: 27605665 DOI: 10.1074/jbc.m116.744615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Indexed: 11/06/2022] Open
Abstract
Approximately 70% of HIV-1 infected patients acquire ocular opportunistic infections and manifest eye disorders during the course of their illness. The mechanisms by which pathogens invade the ocular site, however, are unclear. Under normal circumstances, vascular endothelium and retinal pigment epithelium (RPE), which possess a well developed tight junction complex, form the blood-retinal barrier (BRB) to prevent pathogen invasion. We hypothesize that disruption of the BRB allows pathogen entry into ocular sites. The hypothesis was tested using in vitro models. We discovered that human RPE cells could bind to either HIV-1 gp120 glycoproteins or HIV-1 viral particles. Furthermore, the binding was mediated by dendritic cell-specific intercellular adhesion molecule 3-grabbing non-integrin (DC-SIGN) expressed on RPE cells. Upon gp120 binding to DC-SIGN, cellular NF-κB signaling was triggered, leading to the induction of matrix metalloproteinases, which subsequently degraded tight junction proteins and disrupted the BRB integrity. DC-SIGN knockdown or prior blocking with a specific antibody abolished gp120-induced matrix metalloproteinase expression and reduced the degradation of tight junction proteins. This study elucidates a novel mechanism by which HIV, type 1 invades ocular tissues and provides additional insights into the translocation or invasion process of ocular complication-associated pathogens.
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Affiliation(s)
- Yi-Wen Qian
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chuan Li
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Ai-Ping Jiang
- the Chinese Academy of Sciences Key Laboratory of Molecular Virology and Immunology and
| | - Shengfang Ge
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Ping Gu
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xianqun Fan
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Tai-Sheng Li
- the Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xia Jin
- the Chinese Academy of Sciences Key Laboratory of Molecular Virology and Immunology and.,Viral Disease and Vaccine Translational Research Unit and Vaccine Center, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China, and
| | - Jian-Hua Wang
- the Chinese Academy of Sciences Key Laboratory of Molecular Virology and Immunology and
| | - Zhi-Liang Wang
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China,
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Predictors of HIV/AIDS Related Ocular Manifestations among HIV/AIDS Patients in Felege Hiwot Referral Hospital, Northwest Ethiopia. J Ophthalmol 2015; 2015:965627. [PMID: 26000175 PMCID: PMC4427099 DOI: 10.1155/2015/965627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/17/2015] [Accepted: 04/19/2015] [Indexed: 11/30/2022] Open
Abstract
Background. Ocular manifestations in people living with HIV/AIDS are varied and affect almost all the structures of eye leading to visual impairment or blindness. Therefore, the aim of this study was to identify the predictors of HIV related ocular manifestation among ART clinic clients. Methods. Institution based cross-sectional study was employed among ART clients at Felege Hiwot referral hospital, northwest Ethiopia. The study was conducted from 1 January 2013 to 30 January 2013. A total of 369 systematically and randomly selected clients were included in the study. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 16.0. Binary and multivariable logistic regression analyses were computed to identify independent predictors of HIV related ocular manifestation. Results. Twenty-five percent (25.7%) of HIV patients had ocular manifestations. The three most frequent signs were Squamoid Conjuctival growth (26.9%), ophthalmic herpes zoster (22.1%), and Bacterial Conjuctivitis (17.2%). History of eye problem, CD4 count, and visual acuity of the eye were the predictors of HIV related ocular manifestation. Conclusion. In this study, a higher proportion of ocular manifestations were detected in HIV/AIDS patients. Visual acuity and CD4 counts were the independent predictors of ocular manifestations. This finding gives an insight for policy makers and concerned body to integrate ophthalmic examination in ART clinics to improve the health condition of HIV/ADIS patients.
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The prevalence and causes of visual loss among HIV-infected individuals in Uganda. J Acquir Immune Defic Syndr 2015; 53:95-101. [PMID: 19927007 DOI: 10.1097/qai.0b013e3181c313f0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To determine the prevalence of loss of visual acuity and to describe the ocular diseases associated with vision loss among HIV-infected individuals in Uganda.Methods: One thousand two hundred twelve HIV-positive individuals aged 18 years or older attending an HIV treatment site in Kampala,Uganda, were consecutively screened for loss of visual acuity using a Snellen chart. Those found to have a visual acuity of 6/9 or less in 1 or both eyes had a detailed ocular diagnostic evaluation.Results: One hundred thirty-six patients [11.2%; 95% confidence interval (CI): 9.49–13.13] had a visual acuity of 6/9 or less in at least 1 eye, with 74 (6.1%; 95% CI: 8.54–12.21) having bilaterally reduced presenting visual acuity. Eighty-eight (7.3%; 95% CI: 8.57–12.28)had a visual acuity of 6/18 or worse in at least 1 eye. Ocular diseases associated with reduced vision included cataract 16 (11.8%), optic nerve disease 20 (14.7%), refractive errors 35 (24.3%), and uveitis 44 (32.3%). Other diagnoses observed included diabetic retinopathy,maculopathies, corneal scars, glaucoma, and squamous cell carcinoma of the conjunctiva.Conclusions: Visual impairment and ocular disease affect a large proportion of HIV-infected individuals presenting for HIV care in Uganda. Most causes of vision loss were treatable or could have been prevented with appropriate ophthalmic and medical care.
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Luo J, Jing D, Kozak I, Huiming Z, Siying C, Yezhen Y, xin Q, Luosheng T, Adelman RA, Forster SH. Prevalence of Ocular Manifestations of HIV/AIDS in the Highly Active Antiretroviral Therapy (HAART) Era: A Different Spectrum in Central South China. Ophthalmic Epidemiol 2013; 20:170-5. [DOI: 10.3109/09286586.2013.789530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Evliyaoglu F, Karadag R, Burakgazi AZ. Ocular neuropathy in peripheral neuropathies. Muscle Nerve 2012; 46:681-6. [PMID: 23055310 DOI: 10.1002/mus.23414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ocular movements and coordination require complex and integrated functions of somatic and autonomic nervous systems. Neurological disorders affecting these nervous systems may cause ocular dysfunction involving extraocular muscles and pupils. In this article, the prevalence, clinical presentations, and management of ocular neuropathy related to certain peripheral neuropathies, including diabetic neuropathy, Guillain-Barré syndrome (GBS), chronic inflammatory neuropathies, human immunodeficiency virus (HIV)-associated neuropathy, and hereditary neuropathies, are examined in detail.
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Affiliation(s)
- Ferhat Evliyaoglu
- Department of Ophthalmology, Okmeydani Research and Training Hospital, Istanbul, Turkey
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Kim SJ, Park SJ, Yu HG, Kim NJ, Jang HC, Oh MD. Ocular manifestations of acquired immunodeficiency syndrome in Korea. J Korean Med Sci 2012; 27:542-6. [PMID: 22563221 PMCID: PMC3342547 DOI: 10.3346/jkms.2012.27.5.542] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/26/2012] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Sang Jin Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Chang Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Saxena R, Phuljhele S, Aalok L, Sinha A, Menon V, Sharma P, Mohan A. A rare case of orbital apex syndrome with herpes zoster ophthalmicus in a human immunodeficiency virus-positive patient. Indian J Ophthalmol 2011; 58:527-30. [PMID: 20952840 PMCID: PMC2993986 DOI: 10.4103/0301-4738.71708] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We report a rare instance of favorable outcome in orbital apex syndrome secondary to herpes zoster ophthalmicus (HZO) in a human immunodeficiency virus (HIV)-positive patient. The patient complained of pain and decrease in vision in one eye (20/640) for 2 weeks accompanied with swelling, inability to open eye, and rashes around the periocular area and forehead. The presence of complete ophthalmoplegia, ptosis, relative afferent pupillary defect, and anterior uveitis with decreased corneal sensation prompted a diagnosis of HZO with orbital apex syndrome. The enzyme-linked immunosorbent assay test and a low CD4 count confirmed HIV. Highly active antiretroviral therapy (HAART), systemic acyclovir, and systemic steroids were started. Visual acuity and uveitis improved within 10 days. By the end of the fourth week, ocular motility also recovered and the final visual acuity was 20/25. We highlight the role of HAART, used in conjunction with systemic steroid and acyclovir therapy, in improving the outcome.
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Affiliation(s)
- Rohit Saxena
- Squint and Neuro-Ophthalmology Services, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Lai TYY, Wong RLM, Luk FOJ, Chow VWS, Chan CKM, Lam DSC. Ophthalmic manifestations and risk factors for mortality of HIV patients in the post-highly active anti-retroviral therapy era. Clin Exp Ophthalmol 2010; 39:99-104. [PMID: 20796263 DOI: 10.1111/j.1442-9071.2010.02400.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China.
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Abstract
Cytomegalovirus (CMV) retinitis is the most common cause of vision loss in patients with acquired immunodeficiency syndrome (AIDS). CMV retinitis afflicted 25% to 42% of AIDS patients in the pre-highly active antiretroviral therapy (HAART) era, with most vision loss due to macula-involving retinitis or retinal detachment. The introduction of HAART significantly decreased the incidence and severity of CMV retinitis. Optimal treatment of CMV retinitis requires a thorough evaluation of the patient's immune status and an accurate classification of the retinal lesions. When retinitis is diagnosed, HAART therapy should be started or improved, and anti-CMV therapy with oral valganciclovir, intravenous ganciclovir, foscarnet, or cidofovir should be administered. Selected patients, especially those with zone 1 retinitis, may receive intravitreal drug injections or surgical implantation of a sustained-release ganciclovir reservoir. Effective anti-CMV therapy coupled with HAART significantly decreases the incidence of vision loss and improves patient survival. Immune recovery uveitis and retinal detachments are important causes of moderate to severe loss of vision. Compared with the early years of the AIDS epidemic, the treatment emphasis in the post- HAART era has changed from short-term control of retinitis to long-term preservation of vision. Developing countries face shortages of health care professionals and inadequate supplies of anti-CMV and anti-HIV medications. Intravitreal ganciclovir injections may be the most cost effective strategy to treat CMV retinitis in these areas.
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Affiliation(s)
- Michael W Stewart
- Department of Ophthalmology, Mayo School of Medicine, Jacksonville, FL, USA.
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Farhat F, Daftary MN, Downer GA, Momin F. Managing mentally and physically challenged HIV patients. J Natl Med Assoc 2010; 101:1283-6. [PMID: 20070017 DOI: 10.1016/s0027-9684(15)31140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Management of mentally and physically challenged patients is complex, as it can involve ethical, social, and medical issues, and adding the provision of human immunodeficiency virus (HIV) care further complicates management. There continues to be limited information in the literature in caring for these types of patients. We provide 2 unique HIV cases--one who is mentally challenged and the other who is blind--and how management was approached. A list of select resources to aid both providers and patients is provided.
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Affiliation(s)
- Faria Farhat
- Division of Infectious Disease (Dr Farhat, assistant professor, interim chief), Natvision of Infectious Disease, Clinical Director, NMAETC, Howard University Collegergia Ave NW, Washington, DC 20060, USA.
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Nasoodi A, Lim LT, Al-Ani A, Quah S, Dinsmore WW. What you can see in your patient's eyes? Review of ocular manifestations of HIV in HAART era. Int J STD AIDS 2008; 19:4-11. [DOI: 10.1258/ijsa.2007.005666] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The early diagnosis and treatment of ocular disease to prevent morbidity and mortality of patients with human immunodeficiency virus (HIV) is of paramount importance. Since the advent of highly active antiretroviral therapy (HAART), the incidence of ocular complications of HIV has decreased and their manifestations and natural course are also modified. This has been observed in the face of emerging immune recovery, which per se has brought new difficulties in the process of diagnosing and management of the ocular disease. Conditions such as immune recovery uveitis could affect eyes with history of opportunistic disease with a potential to cause vision loss; with this regard, differentiation of the inflammatory process from infective causes is essential. The other sexually contracted diseases are also to be included in this complex picture because of their contribution to the clinical picture and also sharing common routes of transmission with HIV. There is very little doubt that visual deterioration would further deteriorate the already compromised quality of life of this group of patients. In this review, authors wish to provide evidence available in the medical literature around the visual health issues in HIV-infected patients and raise awareness towards the changing pattern of the ocular disease in the HAART era.
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Affiliation(s)
- A Nasoodi
- Genitourinary Department, Royal Victoria Hospital, Belfast BT12 6BA
| | - L T Lim
- Tennent Institute of Ophthalmology, Glasgow, UK
| | - A Al-Ani
- Tennent Institute of Ophthalmology, Glasgow, UK
| | - S Quah
- Genitourinary Department, Royal Victoria Hospital, Belfast BT12 6BA
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Westeneng AC, Rothova A, de Boer JH, de Groot-Mijnes JDF. Infectious uveitis in immunocompromised patients and the diagnostic value of polymerase chain reaction and Goldmann-Witmer coefficient in aqueous analysis. Am J Ophthalmol 2007; 144:781-5. [PMID: 17707328 DOI: 10.1016/j.ajo.2007.06.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 06/24/2007] [Accepted: 06/26/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To establish the causes of uveitis in immunocompromised patients and to determine the contribution of polymerase chain reaction (PCR) and Goldmann-Witmer coefficient (GWC) analysis of aqueous humor in patients with an infectious etiology. DESIGN Retrospective case series of 56 consecutive immunocompromised patients with uveitis. METHODS All patients underwent full ophthalmologic examination and laboratory blood analysis for uveitis. Aqueous humor analyses were performed using PCR and GWC for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii. RESULTS Of 56 immunocompromised patients, 43 (77%), all posterior and panuveitis, had intraocular infections. Twenty-one (49%) had CMV, three (7%) had VZV, 11 (26%) had T. gondii, six (14%) had Treponema pallidum, and one (2%) each had Aspergillus and Candida. In AIDS patients, CMV was the most common cause. A strong correlation between AIDS and ocular syphilis was also observed (P = .007). In nonAIDS immunocompromised patients, T. gondii was most frequently detected. Twenty-seven patients were examined by both PCR and GWC; five (18.5%) were positive by both assays, 15 (55.5%) were positive by PCR alone and seven (26%) by GWC alone. Viral infections were detected by PCR in 16 of 17 (94%) cases; T. gondii in four of 10 (40%) patients. Using GWC, a viral infection was diagnosed in three of 17 (18%) and T. gondii in nine of 10 (90%) cases. CONCLUSIONS In immunocompromised patients, PCR is superior in diagnosing viral infections. Analysis of intraocular antibody production played a decisive role in the diagnosis of ocular toxoplasmosis.
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Baker ML, Allen P, Shortt J, Lewin SR, Spencer A. Immune recovery uveitis in an HIV-negative individual†. Clin Exp Ophthalmol 2007; 35:189-90. [PMID: 17362465 DOI: 10.1111/j.1442-9071.2006.01439.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immune recovery uveitis (IRU) is an intraocular inflammatory disorder originally described in individuals with human immunodeficiency virus (HIV) and inactive cytomegalovirus retinitis following highly active antiretroviral therapy. Although relatively common in individuals with acquired immune deficiency syndrome in the United States it is an extremely uncommon presentation in Australia. IRU also occurs in iatrogenically immunosuppressed individuals with a similar incidence to HIV-infected individuals. We report one case of IRU in an HIV-negative individual following a volunteer unrelated donor allogeneic stem cell transplant for non-Hodgkin's lymphoma. In the context of tapering the immunosuppression the patient developed bilateral IRU, consisting of panuveitis and macular oedema. The visual acuity (VA) at presentation of IRU was limited to counting fingers bilaterally. The IRU resolved with the re-intensification of the immunosuppression. VA restored to right 6/18 and left 6/12.
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Affiliation(s)
- Dhananjay Shukla
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Affiliation(s)
- M Tariq Bhatti
- Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710, USA
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Affiliation(s)
- Rasha Ali
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Esposito S, Porta A, Bojanin J, Gualtieri L, Cesati L, Vismara E, Principi N. Effect of highly active antiretroviral therapy (HAART) on the natural history of ocular manifestations in HIV-infected children. Eye (Lond) 2006; 20:595-7. [PMID: 16410815 DOI: 10.1038/sj.eye.6702189] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the effect of highly active antiretroviral therapy (HAART) on the natural history of ocular manifestations in HIV-infected children. METHODS All of the HIV-infected children attending the Institute of Pediatrics, University of Milan, Milan, Italy, between 1982 and 2004 were studied. Every 3 months, they were physically examined and underwent indirect fundoscopy conducted by an experienced ophthalmologist; if diagnosed as having eye disease, they were evaluated by the ophthalmologist every week while on specific therapy and monthly thereafter. The clinical and laboratory findings before and after the introduction of HAART were compared. RESULTS The cohort consisted of 117 HIV-infected children (61 males), with a follow-up ranging from 0.09 to 22.31 years (median, 16.33 years). A total of nine cases of ocular involvement (7.7%) were diagnosed between 1983 and 1994, before the introduction of HAART. All nine children died 4-24 months (median, 15 months) after the diagnosis of ophthalmic disease. No case of ocular involvement was observed after the introduction of HAART (P=0.011 vs. before HAART). CONCLUSION The introduction of HAART has had a significant impact on the natural history of ocular manifestations in HIV-infected children, thus suggesting that a reduction in the frequency of ophthalmologic follow-up should be considered for HAART-treated HIV-infected children with immune reconstitution and no visual symptom.
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Affiliation(s)
- S Esposito
- Institute of Pediatrics, University of Milan, Fondazione IRCCS 'Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena', Milan, Italy
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Balba GP, Kumar PN, James AN, Malani A, Palestine AG, Welch JN, Timpone JG. Ocular syphilis in HIV-positive patients receiving highly active antiretroviral therapy. Am J Med 2006; 119:448.e21-5. [PMID: 16651059 DOI: 10.1016/j.amjmed.2005.11.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 11/04/2005] [Accepted: 11/04/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND From October 2001 to October 2002, we have observed a surprisingly high incidence of ocular syphilis in human immunodeficiency virus-positive (HIV+) patients receiving highly active antiretroviral therapy at our clinic. METHODS We conducted a retrospective chart and patient database review. RESULTS From 1997 to 2002, 455 patients in our clinic were screened for syphilis; 320 were screened from 2001 to 2002; 7.3% of patients (33/455) were diagnosed with syphilis. During the past year, syphilis was diagnosed in 7.5% of patients (24/320), of whom 13% (3/24) had ocular syphilis. We estimate the prevalence of ocular syphilis in HIV+ patients on highly active antiretroviral therapy screened for syphilis to be 9% (3/33). Presenting symptoms included blurred vision, loss of vision, central scotomas, and bilateral ocular involvement. The most common ocular manifestation of syphilis was posterior chamber uveitis; one patient also had a retinal detachment. All patients demonstrated reactive rapid plasma reagin and fluorescent treponemal antibody absorption test results, cerebrospinal fluid pleocytosis, and elevated total protein. Each patient received a 21-day course of intravenous penicillin G (24 million units daily) with improvement of visual symptoms. CONCLUSION Our data demonstrate an unexpectedly high incidence of ocular syphilis in our HIV+ patients receiving highly active antiretroviral therapy during the past year. A diagnosis of ocular syphilis should be considered in any HIV+ patient who presents with visual symptoms, irrespective of the patient's CD4 count.
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Affiliation(s)
- Gayle P Balba
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA.
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