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Rubaihayo J, Mbona Tumwesigye N, Birungi J. Temporal and Spatial Distribution of Opportunistic Infections Associated with the Human Immunodeficiency Virus (HIV) in Uganda. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.105344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The human immunodeficiency virus (HIV) remains one of the greatest challenges of the twenty-first century in the absence of an effective vaccine or cure. It is estimated globally that close to 38 million people are currently living with the HIV virus and more than 36 million have succumbed to this deadly virus from the time the first case was reported in early 1980s. The virus degrades the human body immunity and makes it more vulnerable to different kinds of opportunistic infections (OIs). However, with the introduction of highly active anti-retroviral therapy (HAART) in 2003, the pattern and frequency of OIs has been progressively changing though with variations in the different parts of the World. So this chapter discusses the temporal and spatial patterns of OIs in Uganda.
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Babalola Y, Oluleye T, Ashaye A. Vitreoretinal manifestations of human immunodeficiency virus infection and acquired immunodeficiency syndrome in patients attending an antiretroviral therapy clinic in Nigeria: A cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mehta S, Peters RP, Smit DP, Gupta V. Ocular Tuberculosis in HIV-infected Individuals. Ocul Immunol Inflamm 2020; 28:1251-1258. [PMID: 32809898 DOI: 10.1080/09273948.2020.1776882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aim: To review the current literature and publications to assess the clinical features, recommended investigations and treatment for ocular tuberculosis in HIV infected patients. Methods: Literature review. Results: The human immunodeficiency virus (HIV) epidemic affects as many as 37.9 million people. Mycobacterium tuberculosis infection is common in HIV infection and is a leading cause of death and morbidity. Common clinical presentations include anterior uveitis (granulomatous or otherwise), choroidal granulomas/tubercles, chorioretinitis, subretinal abscess, panophthalmitis, retinal detachment and vasculitis. The majority of clinical findings were in the posterior segment, appeared primarily infective (tubercles/chorioretinitis/abscess) and were largely seen in the context of pulmonary tuberculosis or disseminated disease. Current investigational patterns include corroborative tests such as tuberculin skin test or Interferon-γ release assay. Systemic testing includes Computed Tomography, MRI or PET/CT scans. Newer Molecular techniques such as GeneXpert MTB/RIF assay and Line Probe assays (LPA) are increasingly important. Apart from standard ocular anti-inflammatory protocols, anti-tubercular treatment as per the clinical staging (latent or active) needs to be initiated. Initiation of anti-retroviral therapy (ART) is important and can be started soon after ATT. Conclusions: Ocular manifestations within this group are distinct and unique investigational and therapeutic approaches are needed.
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Affiliation(s)
- Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Centre , Mumbai, India
| | - Remco Ph Peters
- Department of Medical Microbiology, University of Pretoria , Pretoria, South Africa.,Department of Medical Microbiology, Maastricht University Medical Centre , Maastricht, The Netherlands.,Foundation for Professional Development, Research Unit , East London, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute , Chandigarh, India
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Jain S, Bajgai P, Kaur S, Dogra M, Sharma A, Sharma K, Katoch D, Dogra MR, Gupta V, Singh R. Ocular Tuberculosis in Human Immunodeficiency Virus and Systemic Tuberculosis Co-infected Patients. Ocul Immunol Inflamm 2020; 29:1002-1006. [PMID: 32083986 DOI: 10.1080/09273948.2020.1714059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the prevalence and clinical findings of ocular tuberculosis (TB) in Human immunodeficiency virus (HIV) and systemic TB co-infected patients.Methods: In this prospective, observational, non-comparative case series, we included HIV and systemic TB co-infected patients, who underwent a detailed ophthalmic and systemic evaluation.Results: Of 85 patients, ocular tuberculosis was seen in eleven patients and their 16 eyes (12.9%). Without the benefit of eye exam, the diagnosis of disseminated TB was missed in 5/52 (9.6%) and 2/25 (8%) of patients clinically assumed to have pulmonary and Extrapulmonary TB, respectively.Conclusion: HIV patients with the disseminated TB have higher risk for ocular TB. As ocular symptoms are rare, still all of them need a detailed ocular examination to look for active ocular TB which will reclassify isolated pulmonary/extrapulmonary to disseminated TB warranting a detailed systemic examination.
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Affiliation(s)
- Sahil Jain
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Bajgai
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cytomegalovirus Retinitis in Patients with AIDS before and after Introduction of HAART in China. Eur J Ophthalmol 2018; 24:209-15. [PMID: 24030539 DOI: 10.5301/ejo.5000354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2013] [Indexed: 11/20/2022]
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Grønborg HL, Jespersen S, Hønge BL, Jensen-Fangel S, Wejse C. Review of cytomegalovirus coinfection in HIV-infected individuals in Africa. Rev Med Virol 2016; 27. [PMID: 27714898 DOI: 10.1002/rmv.1907] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection among HIV-infected individuals may cause end-organ disease, which is an AIDS-defining condition. Evidence from high-income countries suggests that CMV may alter the outcome of HIV infection, other than causing end-organ diseases. We reviewed literature on HIV and CMV coinfection in Africa. METHODS Systematic review of published studies on HIV and CMV coinfection in Africa using the PubMed database. RESULTS High CMV seroprevalence was found throughout Africa, exceeding 90% in most populations. Retinitis, pneumonia, and colitis were the most commonly reported CMV manifestations in HIV-infected individuals. Among patients with pulmonary symptoms, the prevalence of CMV pneumonitis varied from 20% to over 60%, whereas CMV was found in 0% to 14% of patients with gastrointestinal manifestations. Cytomegalovirus retinitis was found in 0% to 2.6% of examined HIV-infected individuals. The diagnostics of CMV end-organ diseases were found complex and difficult to interpret in African settings. Cytomegalovirus viremia was correlated with significantly lower CD4 cell count and increase in activated and apoptosis vulnerable T-lymphocytes. Also, CMV coinfection was found to be associated with increased transmission and progression of HIV infection. Moreover, detectable CMV DNA was an independent predictor of HIV transmission and mortality among HIV-infected individuals. CONCLUSIONS Cytomegalovirus is highly prevalent in Africa and a common cause of disease manifestations in HIV-infected individuals among all age groups. Cytomegalovirus coinfection in HIV-infected individuals in Africa is associated with increased transmission and mortality of HIV, but it is a neglected area of research.
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Affiliation(s)
- Helene Ladefoged Grønborg
- GloHAU, Department of Public Health, Global Health, Aarhus University, Aarhus N, Denmark.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Sanne Jespersen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Bo Langhoff Hønge
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
| | - Søren Jensen-Fangel
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Christian Wejse
- GloHAU, Department of Public Health, Global Health, Aarhus University, Aarhus N, Denmark.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
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Martin-Odoom A, Bonney EY, Opoku DK. Ocular complications in HIV positive patients on antiretroviral therapy in Ghana. BMC Ophthalmol 2016; 16:134. [PMID: 27487853 PMCID: PMC4973055 DOI: 10.1186/s12886-016-0310-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 07/28/2016] [Indexed: 11/15/2022] Open
Abstract
Background Patients infected with human immunodeficiency virus (HIV) usually develop some form of ocular complication in the different segments of the eye due to immune deficiency. In Ghana, data regarding ocular complications among HIV/AIDS patients is scarce. This study investigated the occurrence of ocular complications in HIV infected patients undergoing antiretroviral therapy at the Agogo Presbyterian Hospital in the Ashanti Region of Ghana. Methods Blood samples were taken from 100 confirmed HIV infected patients. The CD4 + T cell count and WHO clinical staging were determined. The patients were taken through thorough ophthalmic assessments to determine any ocular complications. Results Forty-eight patients (48 %) had at least one HIV-related ocular complication. These complications occurred more frequently among those with CD4 counts below 200 cells/μL. Of the participants with HIV-related ocular complications, 11 (23 %) had retinal microvasculopathy, 10 (21 %) showed allergic conjunctivitis, 7 (15 %) had HIV retinopathy and 7 (15 %) had conjunctival carcinoma. All the participants in the study were on first-line antiretroviral therapy; 68 % were females and 72 % were in the Stage 3 of the WHO Clinical Staging of HIV infection. Conclusion The prevalence of ocular complications in HIV positive persons under treatment in Ghana is high. Lower CD4 + T cell counts coupled with age were predisposing factors to HIV-related ocular complications.
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Affiliation(s)
- Alexander Martin-Odoom
- Department of Medical Laboratory Sciences, School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - Evelyn Yayra Bonney
- Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Derek Kofi Opoku
- Department of Medical Laboratory Sciences, School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
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Heiden D, Saranchuk P, Keenan JD, Ford N, Lowinger A, Yen M, McCune J, Rao NA. Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS. THE LANCET. INFECTIOUS DISEASES 2016; 16:493-9. [PMID: 26907735 DOI: 10.1016/s1473-3099(15)00269-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/29/2015] [Accepted: 08/10/2015] [Indexed: 02/04/2023]
Abstract
Choroidal tuberculosis is present in 5-20% of patients with disseminated tuberculosis, and point-of-care dilated binocular indirect ophthalmoscopy eye examination can provide immediate diagnosis. In geographical areas of high tuberculosis prevalence and in susceptible patients (CD4 counts less than 200 cells per μL) detection of choroidal granulomas should be accepted as evidence of disseminated tuberculosis. With training and proper support, eye screening can be done by HIV/AIDS clinicians, allowing early tuberculosis treatment. In regions with a high burden of tuberculosis, we recommend that eye screening be a standard part of the initial assessment of susceptible patients, including at a minimum all patients with HIV/AIDS with CD4 less than 100 cells per μL with or without eye symptoms, and with or without suspicion of disseminated tuberculosis.
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Affiliation(s)
| | - Peter Saranchuk
- Southern Africa Medical Unit, Operational Centre Brussels, Médecins Sans Frontières, Cape Town, South Africa
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Alan Lowinger
- Tufts University School of Medicine, Boston, MA, USA
| | - Michael Yen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph McCune
- Division of Experimental Medicine, University of California, San Francisco, CA, USA
| | - Narsing A Rao
- Ophthalmic Pathology Laboratory and Uveitis Service, USC Eye Institute, Keck School of Medicine, University of Southern California, CA, USA
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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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Bittencourt MG, Agbedia OO, Liu HT, Annam R, Sepah YJ, Leder HA, Sophie R, Ibrahim M, Akhtar A, Akhlaq A, Do DV, Nguyen QD. Ocular complications of HIV/AIDS in the era of HAART. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Bekele S, Gelaw Y, Tessema F. Ocular manifestation of HIV/AIDS and correlation with CD4+ cells count among adult HIV/AIDS patients in Jimma town, Ethiopia: a cross sectional study. BMC Ophthalmol 2013; 13:20. [PMID: 23710936 PMCID: PMC3679865 DOI: 10.1186/1471-2415-13-20] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/21/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND HIV/AIDS is one of twenty first century's challenges to human being with protean manifestation affecting nearly all organs of our body. It is causing high morbidity and mortality especially in sub-Saharan Africa with numerous ocular complications and blindness. The purpose of this study was to determine the patterns of ocular manifestations of HIV/AIDS and their correlation with CD4+T cells count. METHODS A cross-sectional study was done on 348 HIV-positive patients presented to Anti-Retroviral Therapy clinics. Data were collected using face-to-face interview, clinical examination and laboratory investigation, and analyzed using SPSS version 13 software. Statistical association test was done and p<0.05 was considered significant. Other statistical tests like student t-test and logistic regression were also done. RESULTS Of 348 patients, 175 were on antiretroviral therapy and 173 were not on therapy. The mean duration of therapy was 27 months. The overall prevalence of ocular manifestations was 25.3%. The commonest ocular manifestation was keratoconjunctivitis sicca (11.3%) followed by blepharitis (3.2%), molluscum contagiosum (2.6%), conjunctival squamous cell carcinoma (2.3%), conjunctival microvasculopathy (2.3%), cranial nerve palsies (2%), herpes zoster ophthalmicus (HZO) (1.2%), and HIV retinopathy (0.6%). HIV retinopathy and conjunctival microvasculopathy were common in patient with CD4+ count of <200 cells/μl while HZO and molluscum contagiosum were common in patients with CD4+ count of 200-499 cells/μl. Prevalence of ocular manifestation was higher among patients on HAART (32.6%) than those patients not on HAART (17.9%) (p<0.05). There was statistically significant association between ocular manifestation and sex, CD4+Tcells count, and age (p<0.05). CD4+ count, <200 cells/μl and age >35 years were independent risk factors for ocular manifestations. CONCLUSION The study showed that the prevalence of ocular manifestation of HIV/AIDS is lower than previous studies and could be due to antiretroviral therapy. Lower CD4 count is a risk as well as predictor for ocular manifestations.
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Affiliation(s)
- Sisay Bekele
- Department of Ophthalmology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Yeshigeta Gelaw
- Department of Ophthalmology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Fasil Tessema
- Department of Epidemiology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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Ganekal S, Jhanji V, Dorairaj S, Nagarajappa A. Evaluation of Ocular Manifestations and Blindness in HIV/AIDS Patients in a Tertiary Care Hospital in South India. Ocul Immunol Inflamm 2012; 20:336-41. [PMID: 22775065 DOI: 10.3109/09273948.2012.699133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sunil Ganekal
- Nayana Superspecialty Eye Hospital and Research Center, Davangere, Karnataka, India.
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Cytomegalovirus retinitis associated with HIV in resource-constrained settings: systematic screening and case detection. Int Health 2012; 4:86-94. [DOI: 10.1016/j.inhe.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Akçakaya AA, Sargın F, Erbil HH, Aybar A, Sadigov F, Yaylalı SA, Akçay G, Özgüneş N. HIV-related Eye Disease in Patients Presenting to a Tertiary Care Government Hospital in Turkey. Ocul Immunol Inflamm 2012; 20:158-62. [DOI: 10.3109/09273948.2012.676701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pathai S, Gilbert C, Weiss HA, McNally M, Lawn SD. Differing spectrum of HIV-associated ophthalmic disease among patients starting antiretroviral therapy in India and South Africa. Trop Med Int Health 2011; 16:356-9. [PMID: 21371217 PMCID: PMC3128924 DOI: 10.1111/j.1365-3156.2010.02712.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Differences in the prevalence and spectrum of HIV-associated ophthalmic disease in Africa and Asia are not well documented. We studied two comparable cohorts of patients initiating antiretroviral therapy in Mumbai, India, and Cape Town, South Africa. The prevalence of HIV-associated ophthalmic disease was higher in the Indian population (17.5%) than in the South African population (12.1%). This was largely because of vitreo-retinal opportunistic infections (11.4%vs. 2.6%, respectively), notably cytomegalovirus retinitis. This difference persisted after adjusting for confounding factors (adjusted odds ratio = 11.32, 95% confidence interval: 2.67–48.13), confirming a marked geographical difference in the prevalence of HIV-associated retinal disease.
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Affiliation(s)
- Sophia Pathai
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK.
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London NJS, Rathinam SR, Cunningham ET. The epidemiology of uveitis in developing countries. Int Ophthalmol Clin 2010; 50:1-17. [PMID: 20375859 DOI: 10.1097/iio.0b013e3181d2cc6b] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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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. [PMID: 19775470 PMCID: PMC2759932 DOI: 10.1186/1471-2334-9-158] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/23/2009] [Indexed: 11/21/2022] Open
Abstract
Background The ocular manifestations of HIV may lead to visual impairment or blindness. In India, patients typically initiate antiretroviral treatment (ART) with low CD4 cell counts when the risk of ocular complications may be high. The objective of this study was to determine the prevalence and types of HIV-associated ocular conditions in patients referred for ART in India. Methods This cross-sectional study was undertaken at a large public sector ART centre in Mumbai, India. Data collection including a standardised symptom screen, and an ophthalmic examination were performed on all consecutive patients satisfying the criteria for enrolment into the ART clinic irrespective of the presence or absence of ophthalmic/visual symptoms. Results Enrolled patients (n = 149) had a median CD4 cell count of 180 cell/μL (inter-quartile range [IQR], 106-253 cells/μL). The prevalence of HIV-associated ocular disease was 17.5% (95% CI, 11.2-23.6%) in all participants and 23.8% (95% CI: 14.5-33.1) in those with CD4 cell counts <200 cells/μL (n = 84). Only 7.7% of patients with HIV-associated ocular disease reported any eye symptoms in the standardised symptom screen. Objective visual impairment was detected in 20% of those with HIV-associated ocular disease compared to 6% in those without ocular manifestations (p = 0.02). Vitreoretinal disease was the most common manifestation, of which cytomegalovirus retinitis (CMVR) was the most frequent retinal infection (overall prevalence 8.7%, 95% CI: 4.1-13.3%). In a multivariable analysis, HIV-associated ocular disease was independently associated with a CD4 count <100 cells/μL (odds ratio [OR], 6.3, 95% CI: 1.5-25.9) and WHO clinical stages 3 and 4 (OR 9.4, 95% CI: 2.4-37.2). However, symptoms were not independently predictive of ocular disease. Sensitivity of ocular symptom screening was 7.7%, with a positive predictive value of 18% in this population. Conclusion Over a fifth of unselected patients who are eligible for ART in this setting have HIV-related ocular disease of which CMVR is the most common form. Such patients may be at risk of developing ocular immune reconstitution phenomena during ART. Screening for ocular symptoms is not a reliable method to identify those with ocular morbidity and this highlights the need for routine ophthalmic screening prior to commencement of ART.
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Affiliation(s)
- Sophia Pathai
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
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Abstract
This article reviews the magnitude and spectrum of ocular complications of HIV infection in sub-Sahara Africa. A literature search was done using PubMed, Google, and UpToDate and by talking to ophthalmologists and HIV experts working in the region. Ocular complications of HIV infection, mostly retinal, are seen in 29% to 71% of patients. Cytomegalovirus retinitis affects 0% to 16.5% of HIV-infected patients and is treated successfully with intravitreal ganciclovir in South Africa and Botswana. Ocular surface squamous neoplasia is seen in 4% to 7.8% of persons with HIV (a 5%-6% increase in Uganda and Tanzania), and recurrence after surgery occurs in 3.2% to 31.2%. In Zimbabwe, 45% of meningitis in adults is cryptococcal, and cryptococcal meningitis is the third leading cause of death in HIV patients in rural Uganda. In Rwanda, 9% of patients with cryptococcal meningitis developed visual loss and sixth nerve palsy. Thus, HIV infection leads to significant ocular morbidity in sub-Sahara Africa.
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Affiliation(s)
- Oathokwa Nkomazana
- Botswana-University of Pennsylvania Partnership, 2423 Buffalo Close, Gaborone, Botswana.
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Ng WT, Versace P. Ocular association of HIV infection in the era of highly active antiretroviral therapy and the global perspective. Clin Exp Ophthalmol 2005; 33:317-29. [PMID: 15932540 DOI: 10.1111/j.1442-9071.2005.01001.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ocular involvement is a common complication of HIV infection. Since the late 1990s, widespread use of highly active antiretroviral therapy (HAART) has altered the spectrum, and reduced the incidence of ocular involvement in developed countries. The incidence of the most common ocular opportunistic infection, cytomegalovirus retinitis, has decreased tremendously. However, immune recovery uveitis secondary to HAART has emerged as a frequent visually threatening condition. Early diagnosis and treatment with periocular steroids is helpful in minimizing visual loss. Clinicians should also be aware that certain antimicrobial agents used to treat opportunistic infections in HIV-positive patients are associated with potentially serious ocular side effects. In developing countries, where most of the world's 40 million HIV-positive patients live, the spectrum and incidence of ocular involvement differ from those in developed countries. The lack of HAART availability is among the many causes of these differences, which may include nutritional factors, basic medical care availability and the levels of exposure to different infectious agents. These factors add to the already challenging task of treating ocular complications and preventing blindness in HIV-positive patients in developing countries.
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Affiliation(s)
- Weng T Ng
- Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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Affiliation(s)
- Amod Gupta
- Department of Ophthalmology, Post-Graduate Institute of Medical Education and Research. Chandigarh, India 160012
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Klauss V, Schaller UC. [Tropical ophthalmology--prevention and therapy"Vision 2020--the right to sight"]. Ophthalmologe 2004; 101:741-63; quiz 764-5. [PMID: 15205906 DOI: 10.1007/s00347-004-1039-8] [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: 11/30/2022]
Abstract
Worldwide 45 million people are blind, 180 million people are visually handicapped, 90% of all blind people are living in developing countries and 80% of blindness is preventable. The global economic productivity loss due to blindness was estimated to be 19 billion US$ in the year 2000. The initiative "Vision 2020-the right to sight" aims to increase the cataract surgical rate and to eliminate diseases such as trachoma and onchocerciasis as well as avoidable blindness in children. It is planned that blindness in 100 million people can be avoided by the year 2020.
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Affiliation(s)
- V Klauss
- Augenklinik der Ludwig Maximilians Universität, München.
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Abstract
The ocular posterior segment manifestations of AIDS may be divided into four categories: retinal vasculopathy, unusual malignancies, neuro-ophthalmologic abnormalities, and opportunistic infections. Microvasculopathy is the most common manifestation. Opportunistic infections, particularly cytomegalovirus retinitis and progressive outer retinal necrosis, are the most likely to result in visual loss due to infection or subsequent retinal detachment. Diagnosis and treatment are guided by the particular conditions and immune status of the patient.
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Affiliation(s)
- Tamara R Vrabec
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA. Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa. Clin Infect Dis 2003; 36:652-62. [PMID: 12594648 DOI: 10.1086/367655] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2002] [Accepted: 11/25/2002] [Indexed: 11/03/2022] Open
Abstract
Understanding the natural history of human immunodeficiency virus type 1 (HIV-1) and opportunistic infections in sub-Saharan Africa is necessary to optimize strategies for the prophylaxis and treatment of opportunistic infections and to understand the likely impact of antiretroviral therapy. We undertook a systematic review of the literature on HIV-1 infection in sub-Saharan Africa to assess data from recent cohorts and selected cross-sectional studies to delineate rates of opportunistic infections, associated CD4 cell counts, and associated mortality. We searched the MEDLINE database and the Cochrane Database of Systematic Reviews and Cochrane Clinical Trials Register for English-language literature published from 1990 through April 2002. Tuberculosis, bacterial infections, and malaria were identified as the leading causes of HIV-related morbidity across sub-Saharan Africa. Of the few studies that reported CD4 cell counts, the range of cell counts at the time of diagnosis of opportunistic infections was wide. Policies regarding the type and timing of opportunistic infection prophylaxis may be region specific and urgently require further study.
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Affiliation(s)
- Charles B Holmes
- Division of Infectious Disease, Partners AIDS Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Beare N, Kublin JG, Lewis DK, Schijffelen MJ, Peters R, Joaki G, Kumwenda K, Zijlstra EE. Ocular disease in patients with TB and HIV presenting with fever in Malawi. Malawi Med J 2003; 15:6-8. [PMID: 27528946 DOI: 10.4314/mmj.v15i1.10769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS To investigate ocular disease in Malawian patients with tuberculosis (TB) and HIV in presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia. METHODS A prospective study of all adult patients admitted with fever to Queen Elizabeth Central Hospital, Blantyre. All recruited patients had an ophthalmic examination, HIV tests, chest x-ray, sputum examinations, bacterial and mycobacterial blood cultures and malaria slide. RESULTS 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had retinal microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. CONCLUSIONS In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. CMV retinitis is rarely seen in African AIDS patients. This may be due to mortality early in the disease course, or differences in race, HIV sub-type or co-morbidity.
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Affiliation(s)
- Nav Beare
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Wellcome Trust Research Laboratories, Blantyre, Malawi
| | - J G Kublin
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - D K Lewis
- Department of Medicine, College of Medicine, University of Malawi
| | - M J Schijffelen
- Department of Medicine, College of Medicine, University of Malawi
| | - Rph Peters
- Department of Medicine, College of Medicine, University of Malawi
| | - G Joaki
- Department of Microbiology, College of Medicine, University of Malawi
| | - K Kumwenda
- Department of Medicine, College of Medicine, University of Malawi
| | - E E Zijlstra
- Department of Medicine, College of Medicine, University of Malawi
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Beare NAV, Kublin JG, Lewis DK, Schijffelen MJ, Peters RPH, Joaki G, Kumwenda J, Zijlstra EE. Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa. Br J Ophthalmol 2002; 86:1076-9. [PMID: 12234881 PMCID: PMC1771301 DOI: 10.1136/bjo.86.10.1076] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To investigate ocular disease in patients with tuberculosis (TB) and HIV in Africa presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia. METHODS A prospective study of all adult patients admitted with fever to a large central hospital in Malawi, Africa. All recruited patients had an ophthalmic examination, HIV tests, chest x ray, sputum examinations, bacterial and mycobacterial blood cultures, and malaria slide to observe the presence of parasites. RESULTS 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three (2.8% of those with TB) had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. CONCLUSIONS In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. Cytomegalovirus (CMV) retinitis is rarely seen in African AIDS patients. This may be the result of mortality early in the disease course, or differences in race, HIV subtype, or comorbidity.
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Affiliation(s)
- N A V Beare
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
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Abstract
AIM To analyze the prevalence of cytomegalovirus (CMV) retinitis in African AIDS patients. METHOD A Medline survey was carried out to identify reports on the ocular manifestations of HIV infection in African patients. Relevant information on CMV retinitis was identified and analyzed. RESULTS The reported prevalence of CMV retinitis in African AIDS patients varies from 0 to 8.5%. CONCLUSION The low prevalence of CMV retinitis in Africa compared to Europe and the United States suggests that most African patients either die from other diseases before they enter the stage of severe immune depression associated with CMV disease or their survival at this stage is very short. This also explains why bilateral and hence blinding CMV retinitis is rare among African AIDS patients.
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Affiliation(s)
- P Kestelyn
- Department of Ophthalmology, University Hospital, Gent, Belgium
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Morgan D, Jones C, Whitworth J, Ross A, Johnson G. Ocular findings in HIV-1 positive and HIV-1 negative participants in a rural population-based cohort in Uganda. Int Ophthalmol 1999; 22:183-92. [PMID: 10548465 DOI: 10.1023/a:1006241419970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- D Morgan
- Medical Research Council Programme on AIDS/Uganda Virus Research Institute, Entebbe
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Jaffar S, Ariyoshi K, Frith P, Okouchi Y, Sabally S, Ajewole T, Bailey R, Lee PS, Corrah T, Johnson G, Faal H, Whittle H. Retinal manifestations of HIV-1 and HIV-2 infections among hospital patients in The Gambia, west Africa. Trop Med Int Health 1999; 4:487-92. [PMID: 10470340 DOI: 10.1046/j.1365-3156.1999.00425.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In developed countries, 50-75% of AIDS patients develop retinal complications and about 20-40% acquire cytomegalavirus (CMV) retinitis. We conducted a cross-sectional survey to determine prevalence of these in The Gambia where both HIV-1 and HIV-2 infection are present and the prevalence of HIV-1 is rising. METHOD All patients attending hospital whose percentage CD4+ cells (CD4%) was below 14, the level associated typically with an AIDS diagnosis, and one half of those whose CD4% was 14 or above were asked to join the study. Fifty-six HIV-1, 52 HIV-2 and 12 dually infected patients were recruited. Photographs of the fundi were taken and interpreted independently. The findings were related to the patients' percentage CD4+ cells. RESULTS The CD4% was < 14 in 40 patients and < 7 in 17 patients. Thirty-six patients were male. No cases of CMV retinitis were found. Four patients whose CD4% were 4, 5, 11 and 23 had cotton wool spots ranging in number from 1 to 14 for any one patient. The prevalence of cotton wool spots was 8% (95% CI, 0-16%) among patients with CD4% below 14 and 12% (95% CI, 0-27) among patients with CD4% below 7. One of the 4 patients had associated microaneurysm and blot haemorrhages typical of more advanced HIV microvasculopathy. CONCLUSION CMV retinitis is less common in The Gambia than in developed countries. Non-infectious retinopathy may also be less common.
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Affiliation(s)
- S Jaffar
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
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Cochereau I, Mlika-Cabanne N, Godinaud P, Niyongabo T, Poste B, Ngayiragije A, Dazza MC, Aubry P, Larouzé B. AIDS related eye disease in Burundi, Africa. Br J Ophthalmol 1999; 83:339-42. [PMID: 10365044 PMCID: PMC1722983 DOI: 10.1136/bjo.83.3.339] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine the prevalence of ocular manifestations in AIDS patients hospitalised in Bujumbura, Burundi, according to their CD4+ lymphocyte count, serological status for CMV and VZV, and general health status. METHODS Prospective study of 154 consecutive patients who underwent general and ophthalmological examinations, including dilated fundus examination. AIDS was diagnosed on the basis of Bangui criteria and HIV-1 seropositivity. CD4+ lymphocyte counts were determined by the Capcellia method. CMV and VZV antibodies were detected with ELISA methods. RESULTS The mean age was 37 (SD 9) years and 65% of the patients were male. Active tuberculosis was the most frequent underlying disease (61%). Almost all the patients (99%) were seropositive for CMV and VZV. Among the 115 patients for whom CD4+ lymphocyte counts were available, 86 (75%) had more than 100 cells x 10(6)/l. Ocular involvement comprised 16 cases of microangiopathy, six of opalescence of the anterior chamber, five of retinal perivasculitis, two of zoster ophthalmicus, two of viral retinitis, and one of opalescence of the vitreous. CONCLUSION In Africa, the prevalence of ocular involvement in HIV infection is far lower than in Europe and the United States, possibly because most African patients die before ocular opportunistic infections occur.
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Affiliation(s)
- I Cochereau
- IMEA/INSERM U13, Hôpital Bichat, Paris, France
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O'Keefe EA, Wood R, Van Zyl A, Cariem AK. Human immunodeficiency virus-related abdominal pain in South Africa. Aetiology, diagnosis and survival. Scand J Gastroenterol 1998; 33:212-7. [PMID: 9517535 DOI: 10.1080/00365529850166978] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abdominal pain in acquired immunodeficiency syndrome (AIDS) patients is often a marker of an underlying opportunistic pathologic condition. There are no data on HIV-related abdominal pain in Africa. METHODS Forty-four consecutive Cape Town patients with advanced human immunodeficiency virus (HIV) infection (CD4 < 200) and abdominal pain were studied prospectively to determine aetiology and survival. RESULTS A probable cause of pain was identified in 37 (84%): disseminated Mycobacterium tuberculosis infection in 11, cryptosporidiosis in 6, cytomegalovirus infection in 6, and atypical mycobacterial infection in 2. Gastrointestinal lymphoma and pancreatitis were not seen. Fever, hepatomegaly, respiratory symptoms, abnormal chest radiograph, and adenopathy, ascites, or abscesses on ultrasound had predictive diagnostic value for disseminated M. tuberculosis. Fifty-one per cent of abdominal pain patients survived 6 months, compared with 73% of all AIDS patients (P < 0.001). CONCLUSIONS The aetiology of HIV-related abdominal pain in Cape Town reflects the high local prevalence of tuberculosis. Clinical and ultrasound features facilitate diagnosis. Abdominal pain is associated with poor survival.
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Affiliation(s)
- E A O'Keefe
- Dept. of Medicine, University of Cape Town, Somerset Hospital, Greenpoint, South Africa
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Burke M, Yust I, Katlama C, Vardinon N, Clumeck N, Pinching AJ, Ledergerber B, Gatell JM, Chiesi A, Barton SE, Lundgren JD, Pedersen C. Cytomegalovirus retinitis in patients with AIDS in Europe. AIDS in Europe Study Group. Eur J Clin Microbiol Infect Dis 1997; 16:876-82. [PMID: 9495667 DOI: 10.1007/bf01700553] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of cytomegalovirus (CMV) retinitis and risk factors associated with the condition were studied in patients with the acquired immune deficiency syndrome (AIDS) in a multicenter retrospective cohort study of 6458 patients from 52 centers in 17 countries in Europe. Cytomegalovirus retinitis was diagnosed in 154 patients (2.4%) at the time of AIDS diagnosis, the probability of this diagnosis being significantly higher for those with CD4+ cell counts of < 100/mm3 (3.4%) than with counts of 100-200/mm3 (1.3%) or > 200/mm3 (0.8%). The rate of developing CMV retinitis after AIDS diagnosis was 9.4 per 100 patient years of follow-up. Multivariate analysis showed that risk behavior was significantly associated with the risk of developing CMV retinitis: lower for intravenous drug users [relative risk (RR) 0.47] and those engaged in "other risk behavior" (RR 0.58) than for homosexual men. The risk of developing CMV retinitis after AIDS diagnosis was significantly associated with CD4+ cell count at the time of AIDS diagnosis: for counts < 100/mm3 (RR 2.90) and from 100 to 200/mm3 (RR 2.13), there was a higher risk than for counts > 200/mm3. Patients with Pneumocystis carinii pneumonia, toxoplasmosis, or extraocular CMV infection at time of AIDS diagnosis exhibited an increased risk of developing CMV retinitis. Patients treated with zidovudine exhibited an increased rate of CMV retinitis: RR was 1.75 during and 2.87 after the second year of treatment as compared to those who had not received zidovudine. Median survival after CMV retinitis at time of AIDS diagnosis was eight months.
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Affiliation(s)
- M Burke
- Department of Medicine A and Clinical Immunology, Ichilov Hospital, Tel Aviv, Israel
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Abstract
HIV has infected more than 10 million people in sub-Saharan Africa with prevalence rates of up to 30% reported from some countries. Adult transmission of HIV in Africa is mainly heterosexual and over half of new infections are in women. About 40% of infants born to HIV-positive mothers are themselves infected. Diarrhoea occurs in 90% of African AIDS patients and 'slim disease' (prolonged diarrhoea and wasting usually due to coccidian parasites) is pathognomic of AIDS in Central Africa. Dual infection with HIV and tuberculosis is a major problem. African AIDS patients appear to succumb to virulent pathogens, especially Mycobacterium tuberculosis, before they become sufficiently immunosuppressed to develop the opportunistic infections typically associated with advanced HIV disease in developed countries.
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Affiliation(s)
- E A O'Keefe
- Dept. of Medicine, University of Cape Town, Somerset Hospital, Greenpoint, South Africa
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