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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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Makunyane PS, Mathebula SD. Ocular manifestations of HIV and AIDS patients on antiretroviral therapy in a tertiary hospital in South Africa. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) causes impairment to the immune system, which then leads to immunocompromised conditions, and allows for opportunistic infection to invade many organs of the human body. Ocular involvement is very common; the various ocular complications may be asymptomatic and they may be the initial manifestations of the underlying diseases.Aim: This study aimed to determine the prevalence and the type of ocular manifestations that occur in HIV and AIDS patients.Setting: The study was conducted on ART (antiretroviral treatment) clinic patients in the Department of Ophthalmology at the Steve Biko Academic Hospital, Pretoria.Methods: This descriptive, cross-sectional study was conducted on HIV and AIDS patients referred from the ART clinic for complete ophthalmological evaluation, irrespective of the immune system status and presence or absence of symptoms. All the participants underwent an ophthalmologic evaluation, which included case history and ocular examinations of both anterior and posterior segments.Results: Out of the 177 participants, 72.3% had visual acuity of between 6/3 to 6/18, 10% had poor vision, 7% had lost one eye to ocular complications and 5% were blind. The most common anterior segment manifestations were uveitis and dry eye, whilst HIV-related retinopathy and papilledema were the most prevalent conditions in the posterior segment. Only three participants had third cranial nerve palsy.Conclusion: The prevalence of ocular manifestations was significantly higher with lower CD4+ cell counts, which could be regarded as predictors for the occurrence of ocular morbidity in HIV and AIDS patients.
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Liu Q, Xu ZY, Wang XL, Huang XM, Zheng WL, Li MJ, Xiao F, Ouyang PW, Yang XH, Cui YH, Pan HW. Changes in Conjunctival Microbiota Associated With HIV Infection and Antiretroviral Therapy. Invest Ophthalmol Vis Sci 2021; 62:1. [PMID: 34473190 PMCID: PMC8419876 DOI: 10.1167/iovs.62.12.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose HIV infection is associated with a variety of ocular surface diseases. Understanding the difference of the ocular microbiota between HIV-infected and healthy individuals as well as the influence of antiretroviral therapy will help to investigate the pathogenesis of these conditions. Methods A cross-sectional study was conducted on subjects including HIV-negative individuals, untreated HIV-infected individuals, and HIV-infected individuals with antiretroviral therapy. Conjunctival microbiota was assessed by bacterial 16S rRNA sequencing of the samples obtained from the conjunctival swab. Results The microbial richness in ocular surface was similar in HIV-negative, untreated HIV-positive, and highly active antiretroviral therapy (HAART) subjects. The bacterial compositions were similar in the two HIV infection groups but were significantly different from the HIV-negative group. HAART changed the beta diversity of bacterial community as determined by Shannon index. CD4+ T cell count had no significant influence on the diversity of ocular microbiota in HIV-infected individuals. Conclusions The data revealed the compositional and structural difference in conjunctival microbial community in subjects with and without HIV infection, indicating that HIV infection or its treatment, may contribute to ocular surface dysbiosis.
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Affiliation(s)
- Qun Liu
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Zhi-Yi Xu
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, China
| | - Xiao-Li Wang
- Department of Ophthalmology, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Xiao-Mei Huang
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Wen-Lin Zheng
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Mei-Jun Li
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Fan Xiao
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Pei-Wen Ouyang
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiao-Hua Yang
- Department of Histology and Embryology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Yu-Hong Cui
- Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
- Department of Histology and Embryology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Hong-Wei Pan
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
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Arora R, Sandhu N, Dokania P, Subramanian A. Ocular Manifestations in Patients of HIV(Human Immunodeficiency Virus) Infection on Combined Anti-Retroviral Therapy (CART). Ocul Immunol Inflamm 2021; 30:1399-1407. [PMID: 33793390 DOI: 10.1080/09273948.2021.1881562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim: To determine the prevalence and spectrum of ocular manifestations in PLHIV (people living with Human Immunodeficiency Virus) on cART (combined Antiretroviral Therapy) and correlate them with WHO clinical staging, CD4 count, duration & type of cART.Methods: Observational cross-sectional study. Ophthalmic evaluation of 350 PLHIV on cART (at least 6 months) was done. Logistic regression was done to correlate ocular findings with different variables. Results: Prevalence of ocular, anterior & posterior segment manifestations was 15.71%, 10.86%, and 4.00%, respectively. Dry eye(8.00%) being the most common finding. PLHIV with CD4 count ≤350 (OR = 3.1,p < 0.001), in WHO stage 3 (OR = 26.9,p = 0.004) & 4(OR = 60.7,p < 0.001) & on 3rdlineART were at much higher risk of ocular manifestations as compared to those on 2nd (OR = 2.83) and 1stline (OR = 6.6) of therapy. Duration of treatment had a protective (p = 0.01) effect on bilateral manifestations.Conclusion: With early initiation of ART, there is significant reduction in the overall prevalence of ocular findings, in the number of opportunistic ophthalmic infections and blinding disorders. Of all the reported ocular findings, anterior segment disorder emerged more often.
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Affiliation(s)
- Ritu Arora
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi University, New Delhi, India
| | - Neha Sandhu
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi University, New Delhi, India
| | - Pallavi Dokania
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi University, New Delhi, India
| | - Anuradha Subramanian
- Department of Medicine, Nodal Officer, ART Centre, Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi University, New Delhi, India
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Saadouli D, Ammari L, Ben Mansour K, Yahyaoui Y, Aissa S, Mohamed Ali EA, Yahyaoui S, Tiouri H. Ocular manifestations of people living with HIV in Tunisia. South Afr J HIV Med 2021; 22:1193. [PMID: 33824735 PMCID: PMC8008002 DOI: 10.4102/sajhivmed.v22i1.1193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 11/03/2022] Open
Abstract
Background Ocular involvement is a common complication of human immunodeficiency virus (HIV). Knowledge about this topic in Tunisia is limited. Objective To investigate ophthalmic manifestations in patients living with HIV in Tunisia. Method This was an observational study, performed between January 2007 and December 2016. We included patients with ocular disorders related to HIV. The data were recorded retrospectively from chart review. Results Amongst 98 people living with HIV (PLWH), 36 participants (55 eyes) had ocular manifestations. The mean age was 32.2 ± 5.6 years. Twenty-four patients were men and 12 were women. The mean value of CD4+ T-cell count was 156.5 ± 4.2 cells/µL. Bilateral lesions were found in 19 eyes. Best corrected visual acuity was better than 6/12 in 36 eyes. The most common ocular finding was dry eye syndrome (22%), cotton-wool spots (20%) and retinal haemorrhage (16%) followed by cytomegalovirus (CMV) retinitis (9%), anterior uveitis (7%), toxoplasmosis (4%) and tuberculosis retinochoroiditis (7%) Herpetic keratitis (5%), Herpes zoster ophthalmicus (2%) and syphilitic chorioretinitis (2%). Papilledema was found in three eyes (5%). Panuveitis was observed in four eyes (7%): three of them were associated with chorioretinal toxoplasmosis, syphilitic chorioretinitis and CMV retinitis. The fourth was attributable to immune recovery uveitis. A CD4+ T-cell count of ≤ 200 cells/µL was found to be an independent risk factor for developing posterior segment manifestations. Conclusion Various ophthalmic manifestations were observed in PLWH. The most common lesion was retinopathy. Ocular involvement can be serious leading to poor visual prognosis, which requires close collaboration between the ophthalmologist and infectious disease physician.
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Affiliation(s)
- Dorsaf Saadouli
- Department of Ophthalmology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Lamia Ammari
- Department of Infectious Diseases, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Khaoula Ben Mansour
- Department of Ophthalmology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yosra Yahyaoui
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sameh Aissa
- Department of Infectious Diseases, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - El Afrit Mohamed Ali
- Department of Ophthalmology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Salem Yahyaoui
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Hanene Tiouri
- Department of Infectious Diseases, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Li W, Wang X, Yang Y, Zhao L, Lin D, Wang J, Zhu Y, Chen C, Liu Z, Wu X, Zhang X, Wang R, Li R, Ting DSW, Huang W, Lin H. The associations of population mobility in HIV disease severity and mortality rate in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:315. [PMID: 33708942 PMCID: PMC7944320 DOI: 10.21037/atm-20-4514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Human immunodeficiency virus (HIV) infection has become a chronic disease and attracted public attention globally. Population migration was considered hindering the control and management of HIV infection, but limited studies have explored how population mobility could influence the development of HIV-related complications and overall prognosis. Methods We enrolled hospitalized HIV patients in this cross-sectional study between January 1, 2006, and December 31, 2016. We extracted demographic, hospitalization, and patient diagnosis data. Patients were divided into three groups according to the population type: (I) resident of Guangzhou City (local resident); (II) migrant outside of Guangzhou City but within Guangdong Province (migrant within the province); and (III) migrant outside of Guangdong Province (migrant outside the province). To represent the prognosis of HIV, in-hospital death was defined as the worst outcome, whereas vision-related events were considered moderate-to-severe complications. Logistic regression models were used to analyze factors influencing the prognosis of HIV. Results Eight thousand and six hundred thirty-one inpatients (14,954 cases) were enrolled. The overall mortality was 7.9%, decreasing from 21.5% in 2006 to 3.8% in 2016. The prevalence of vision-related events was 14.4% between 2015 and 2016. Compared to local patients, migrant patients (within and outside the province) were younger, had significantly less access to health insurance, fewer hospitalization admissions, longer hospital stays, and a higher proportion of physical work (P<0.01). Furthermore, they had a higher prevalence of vision-related events (16.2% and 17.4% in migrant patients within the province and outside the province, respectively vs. 9.5%) and infectious diseases, but lower in-hospital mortality (5.9% and 7.0% vs. 12.3%) than local patients. Migrants correlated negatively with in-hospital death [odds ratio (OR) 95% CI, 0.37 (0.29–0.48) and 0.52 (0.40–0.68)] but correlated positively with vision-related events [OR (95% CI), 2.08 (1.54–2.80) and 2.03 (1.47–2.80)]. Conclusions Migrant patients have significantly poorer access to health insurance, with an increased risk of developing moderate-to-severe HIV infection but a decreased risk of in-hospital death, indicating a trend toward withdrawing treatment in migrant patients when they have advanced diseases. Managements such as optimizing access to health insurance and improving follow-up visits for HIV infection should be considered in the context of the population mobility of HIV patients.
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Affiliation(s)
- Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoli Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
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Li W, Wang X, Zhao L, Lin D, Yang Y, Liu Z, Wu X, Wang J, Zhu Y, Chen C, Zhang X, Wang R, Li R, Huang X, Huang W, Lin H. The value and implementation of routine ophthalmic examination in the era of HAART. EClinicalMedicine 2021; 31:100646. [PMID: 33385122 PMCID: PMC7772547 DOI: 10.1016/j.eclinm.2020.100646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The high prevalence of ocular manifestations (OMs) in patients with human immunodeficiency virus (HIV) infection and chronic diseases such as diabetes has become a global health issue. However, there is still a lack of an appropriate ophthalmic diagnostic procedure for the early detection of OMs in this population, leading to the risk of an irreversible visual impairment that substantially affects the quality of life of these patients. METHODS The Guangzhou HIV Infection Study was a retrospective study that enrolled hospitalised HIV-infected patients in Guangzhou between January 2005 and December 2016, period corresponding to the highly active antiretroviral therapy (HAART) era in China. We collected data on OMs, systemic diseases, hospitalisation, and demographic characteristics. We classified the patients into 3 groups according to the ophthalmic examination mode they underwent: the non-ophthalmologist examination group (patients hospitalised in 2005-2011 who were only treated by infectious disease physicians), the on-demand ophthalmic examination group (patients hospitalised in 2012-2013 who were referred for a consultation with an ophthalmologist), and the routine ophthalmic examination group (patients hospitalised in 2014-2016 who routinely underwent standard ophthalmic examinations). Binary logistic regression models were used to investigate the factors related to OMs. FINDINGS A total of 8,743 hospitalised HIV-infected patients were enrolled. The prevalence of detected OMs were 1.5% in the non-ophthalmologist examination group, 1.9% in the on-demand ophthalmic examination group, and 12.8% in the routine ophthalmic examination group. The odds of detection of OMs were highest in the routine ophthalmic examination group (adjusted odds ratio [aOR]=9.24, [95%CI, 6.51-13.12], compared to the non-ophthalmologist examination group). The detection of all types of OMs increased substantially, with keratitis, retinitis and vascular abnormalities increased the most (by 15.8-20.0 times). In the routine examination group, patients who were older than 50 years, males, with medical insurance, and were not resident in Guangzhou, had higher odds to have OMs. Several systemic diseases also increased the odds of OMs, with the highest odds among patients with a cytomegalovirus infection (aOR=5.59, [95%CI, 4.12-7.59]). Patients with retinitis, retinopathy and conjunctivitis had higher odds of having a CD4+ T cell counts less than 200 cells/μL compared to the patients that did not have these referred OMs. INTERPRETATION The implementation of a routine ophthalmic examination has improved the odds of OM detection by approximately 9 times and increased the diagnosis rates of all types of OMs. Therefore, we encourage all HIV-infected patients to undergo regular ophthalmic examinations. Patients with OMs, especially retinopathy and retinitis, need to be evaluated for immune function (such as CD4+ T cell counts) and systemic diseases.
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Affiliation(s)
- Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Xiaoli Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510000, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Xiaoman Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
- Center of Precision Medicine, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
- Corresponding author.
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Peters RPH, Kestelyn PG, Zierhut M, Kempen JH. The Changing Global Epidemic of HIV and Ocular Disease. Ocul Immunol Inflamm 2020; 28:1007-1014. [PMID: 32396027 DOI: 10.1080/09273948.2020.1751214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: Overview of the evolving epidemiology of human immunodeficiency virus (HIV)-related ocular disease over time. Method: Narrative review. Results: HIV enhances susceptibility to opportunistic eye infections, has direct pathogenic effects, and places patients at risk of immune recovery inflammatory syndromes in previously infected eyes after starting highly-active antiretroviral therapy (HAART). Widespread availability of HAART has resulted in a decrease of infectious ocular conditions such as cytomegalovirus retinitis, toxoplasmic retinitis, squamous cell carcinoma of the conjunctiva, and microvascular retinopathy. However, large coexisting burdens of tuberculosis, herpesvirus infection and syphilis (among others) continue to contribute to the burden of ocular disease, especially in low-resource settings. Growing risks of cataract, retinopathy and retinal nerve fiber thinning can affect patients with chronic HIV on HAART; thought due to chronic inflammation and immune activation. Conclusion: The changing epidemic of ocular disease in HIV-infected patients warrants close monitoring and identification of interventions that can help reduce the imminent burden of disease.
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Affiliation(s)
- Remco P H Peters
- Foundation for Professional Development, Research Unit , East London, South Africa.,Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria , Pretoria, South Africa.,Department of Medical Microbiology, Maastricht University Medical Centre, CAPRHI School of Public Health & Primary Care , Maastricht, The Netherlands
| | | | - Manfred Zierhut
- Department of Ophthalmology, University of Tuebingen , Tübingen, Germany
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear , Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School , Boston, Massachusetts, USA.,MCM Eye Unit, MyungSung Christian Medical Center and MyungSung Medical School , Addis Ababa, Ethiopia
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9
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Nguyen BN, Chung AW, Lopez E, Silvers J, Kent HE, Kent SJ, Downie LE. Meibomian gland dropout is associated with immunodeficiency at HIV diagnosis: Implications for dry eye disease. Ocul Surf 2020; 18:206-213. [PMID: 32081622 DOI: 10.1016/j.jtos.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/05/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022]
Abstract
AIM To characterize anterior eye health and tear film characteristics in individuals with human immunodeficiency virus (HIV) undergoing anti-retroviral therapy. METHODS This cross-sectional study involved 35 adults, categorized as healthy controls (n = 18) or as HIV-positive patients (n = 17), with no history of opportunistic infection or current ocular fundus abnormalities. Participants underwent a comprehensive anterior eye assessment. Primary outcome measures were dry eye symptoms (Ocular Surface Disease Index survey), tear film osmolarity, and extent of meibomian gland dropout. Secondary outcomes measures were ocular redness, tear film stability, and ocular surface staining. Levels of 36 cytokines were assayed from basal tears using a multiplex bead array. RESULTS The HIV-positive group showed more extensive meibomian gland dropout relative to controls (mean ± SD, controls: 29.6 ± 5.8 versus 37.0 ± 13.9%, p = 0.045). The extent of meibomian gland dropout was negatively correlated with blood CD4 T-cell count (a marker of immunodeficiency) at diagnosis (r = -0.69, p = 0.006). All other tests of anterior ocular health, including dry eye symptom levels, were not significantly different between the groups. There were no significant inter-group differences for the 36 cytokines assayed in the tear film. CONCLUSIONS We find greater meibomian gland dropout in HIV-positive individuals that is related to disease severity at diagnosis. Given this feature predisposes to dry eye disease, it suggests the need for long-term studies of anterior eye health in people with HIV.
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Affiliation(s)
- Bao N Nguyen
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia
| | - Amy W Chung
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Australia
| | - Ester Lopez
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Australia
| | - Julie Silvers
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Helen E Kent
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia.
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent changes in opportunistic ocular infections (OOIs) in the era of modern combination antiretroviral therapy (cART), in the setting of HIV-infected patients. RECENT FINDINGS Improvements in modern cART has led to a progressive decline in the incidence of OOIs and mortality among patients with AIDS. Not only has there been a decreasing incidence of cytomegalovirus (CMV) retinitis, but there also has been a decline in progression of such retinitis when it does occur in AIDS patients, since the introduction of cART. Nevertheless, CMV retinitis remains the major cause of vision loss in AIDS patients. Although the incidence of CMV retinitis has declined overall, the incidence of ocular syphilis has increased during the cART era. Moreover, the impact of having HIV plays a role with respect to multidrug-resistant (MDR) tuberculosis and has resulted in a high prevalence of presumed ocular tuberculosis in HIV/MDR-TB co-infected patients. Although immune reconstitution uveitis (IRU) has been an important cause of visual deficits in developed countries, OOIs remain an important cause of blindness in the developing world. SUMMARY Reconstituting the immune system with effective cART while increasing accessibility of screening examinations is key to the success of blindness prevent in HIV-infected individuals, particularly in developing countries.
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Contribution of HIV Infection, AIDS, and Antiretroviral Therapy to Exocrine Pathogenesis in Salivary and Lacrimal Glands. Int J Mol Sci 2018; 19:ijms19092747. [PMID: 30217034 PMCID: PMC6164028 DOI: 10.3390/ijms19092747] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023] Open
Abstract
The structure and function of exocrine glands are negatively affected by human immunodeficiency virus (HIV) infection and its co-morbidities, including innate and adaptive immune responses. At the same time, exocrine function may also be influenced by pharmacotherapies directed at the infectious agents. Here, we briefly review the role of the salivary glands and lacrimal glands in normal physiology and exocrine pathogenesis within the context of HIV infection and acquired immune deficiency syndrome (AIDS), including the contribution of antiretroviral therapies on both. Subsequently, we discuss the impact of HIV infection and the types of antiretroviral therapy on disease management and therapy development efforts.
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Jin C, Minhas H, Kaur A, Kodali S, Gotlieb V. A Case of Ocular Kaposi's Sarcoma Successfully Treated with Highly Active Antiretroviral Therapy (HAART) Combined with Docetaxel. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1074-1077. [PMID: 30197412 PMCID: PMC6140454 DOI: 10.12659/ajcr.910374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Patient: Male, 24 Final Diagnosis: Ocular Kaposi’s sarcoma Symptoms: Eyelid swelling • red eye Medication: — Clinical Procedure: Biopsy Specialty: Oncology
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Affiliation(s)
- Chongfei Jin
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.,Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Hamza Minhas
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Amandeep Kaur
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Sreenath Kodali
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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