Anterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome

Ophthalmological Manifestations in People with HIV from Northeastern Romania

Background and Objectives: Although ocular disorders can occasionally impact people with HIV over the course of their illness, HIV/AIDS is unmistakably a multisystem disorder. A physician can rule out a wide range of ophthalmic problems with the assistance of an ophthalmologist, from adnexal disorders to posterior segment diseases, including those affecting the optic tract and optic nerve. Materials and Methods: Based on patient medical data from the "St. Parascheva" Clinical Hospital of Infectious Diseases in Iasi, we carried out a retrospective clinical investigation on patients with HIV/AIDS and ophthalmological conditions who were hospitalized in northeastern Romania. We seek to draw attention to the characteristics and ophthalmological comorbidities of HIV/AIDS patients. The studied period was between 1 January 1991 and 31 December 2022. Results: There were a total of 38 recorded cases of ophthalmological manifestations in the HIV-infected patients. The research group's average age was 37.31 years old (standard deviation 9.5693917). Males were primarily impacted, having lower total CD4+ T-lymphocyte levels based on sex and CD4+ T-lymphocyte levels overall. The HIV viral load was 999 268.13 copies/mL on average (standard deviation 1,653,722.9). Of all the patients, we found out that 17 had congenital eye diseases (44.73%) and the others (21, 55.26%) developed ophthalmological diseases. CMV Retinitis was found most frequently, in eight patients (21.05%), followed by Myopia in seven patients (18.42%). Conclusions: The key to the management of HIV-positive patients is a multidisciplinary approach and access to antiretroviral therapy. Anyone who is HIV-positive and experiences ocular symptoms at any time should be directed to seek professional ophthalmologic treatment as soon as feasible. A therapeutic holdup could result in irreversible vision loss. Long-term coordination is required to combat this disease, improving communication between the ophthalmology and infectious disease fields.

When HIV Immunodeficiency and Heterochromia Confuse the Issue: Recurrent Zoster Uveitis Mistaken for Fuchs' Uveitis

Purpose

We report a case with iris heterochromia misdiagnosed as Fuchs' uveitis which finally turned out to be a unilateral zoster uveitis in an HIV-positive patient.

Case Report

A 45-year old patient was seen for a recurrent right anterior uveitis treated with prednisolone 1% drops BID. The iris of the right eye was hypochromic and atrophic and several small granulomatous keratic precipitates (KPs) were present. After discontinuation of corticosteroid drops, severe uveitis developed with mutton-fat KPs, and laser flare photometry (LFP) increased from 20 to 50.3 ph/ms. He had presented with right zoster ophthalmicus two years earlier and HIV-serology revealed to be positive.

Conclusion

Iris heterochromia is not a good disease-defining criterion for Fuch's uveitis even when typical KPs are present and can lead to misdiagnosis. More reliable criteria including stellate KPs, low LFP values, absence of synechiae, vitreitis, and disc hyperfluorescence, all absent in this case, should be sought to confirm or exclude the diagnosis.

Ocular Manifestations in Patients of HIV(Human Immunodeficiency Virus) Infection on Combined Anti-Retroviral Therapy (CART)

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 3^rdlineART were at much higher risk of ocular manifestations as compared to those on 2^nd (OR = 2.83) and 1^stline (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.

Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy - An update

Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.

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

Background & objectives:

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

Methods:

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

Results:

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

Interpretation & conclusions:

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

Corneal and Anterior Chamber Morphology in Human Immunodeficiency Virus-1-Infected Patients Without Opportunistic Infections

OBJECTIVES

To evaluate corneal and anterior chamber morphology as measured by Pentacam HR in human immunodeficiency virus (HIV)-infected patients without opportunistic infections and to search for signs of accelerated aging.

METHODS

This prospective study included 41 eyes of 41 HIV-1-infected patients (study group) and 50 eyes of 50 healthy subjects (control group). Specular microscope and Pentacam HR were used for corneal and anterior chamber morphology evaluation. Corneal endothelial cell density (CECD), hexagonal cell ratio, coefficient of variation, corneal thickness, density and volume, maximum keratometry, anterior chamber volume (ACV), and anterior chamber depth (ACD) measurements were recorded for analysis.

RESULTS

The mean CD4 count was 428.3±231.9 (36-950) cells/mL, and the time since diagnosis was 27.5±34.1 months in the study group. The difference in anterior segment parameters was not significantly different between the study and the control groups (P>0.05). Age significantly correlated with CECD (r=-0.436, P=0.004), ACV (r=-0.570, P<0.001), ACD (r=-0.471, P=0.002), and corneal density (r=0.424, P=0.006) in the study group, whereas it did not show a significant correlation with any ocular parameters in the control group (Pearson correlation).

CONCLUSION

Corneal density, CECD, ACV, and ACD showed significant correlation with age in HIV-1-infected patients. Further studies are needed to show whether ocular parameters may serve as useful tools to monitor HIV-related accelerated aging.

Real-time polymerase chain reaction for diagnosis and management of HIV-induced uveitis

Intraocular (IO) inflammation in patients with Human immune deficiency virus (HIV) infection can be due to opportunistic infections, immune recovery uveitis, drugs used in the management or a primary manifestation of HIV itself. We studied the role of RT-PCR for HIV RNA in confirming the diagnosis of HIV induced uveitis and its useful in the management and follow-up of these patients.

Opportunistic ocular infections in the setting of HIV

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.

Contribution of HIV Infection, AIDS, and Antiretroviral Therapy to Exocrine Pathogenesis in Salivary and Lacrimal Glands

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.

HIV-infected individuals on long-term antiretroviral therapy are at higher risk for ocular disease

Introduction of antiretroviral therapy (ART) has dramatically reduced the incidence of infectious ocular diseases in human immunodeficiency virus (HIV)-infected individuals. However, the effects of long-term ART and chronic HIV infection on the eye are ill-defined. This study determined the occurrence and severity of ocular diseases among 342 participants in a rural South African setting: HIV-naïve (n = 105), HIV-infected ART-naïve (n = 16), HIV-infected on ART for 36 months (long-term ART; n = 165). More HIV-infected participants presented with an external eye condition, in particular blepharitis, than HIV-naïve individuals (18% vs. 7%; age-adjusted odds ratio (aOR) = 2·8, P < 0·05). Anterior segment conditions (particularly keratoconjunctivitis sicca and pterygium) were also more common (50% vs. 27%; aOR = 2·4; P < 0·01). Compared with individuals on short-term ART, participants receiving long-term ART were more likely to have clinically detectable cataract (57% vs. 38%; aOR = 2·2, P = 0·01) and posterior segment diseases, especially HIV retinopathy (30% vs. 11%; aOR = 3·4, P < 0·05). Finally, long-term ART was significantly associated with presence of HIV retinopathy (P < 0·01). These data implicate that ocular disease is more common and of more diverse etiology among HIV-infected individuals, especially those on long-term ART and suggest that regular ophthalmological monitoring of HIV-infected individuals on ART is warranted.

A distinct cytokines profile in tear film of dry eye disease (DED) patients with HIV infection

PURPOSE

To investigate the tear cytokine profile in HIV patients with dry eye disease (DED) and study the association between the severity of ocular inflammatory complications and tear cytokines levels. We postulate that HIV-mediated inflammation may be the underlying pathogenic mechanism for HIV-associated DED.

METHODS

The current prospective case-control study compared tear film cytokine profiles in DED patients with HIV infection (n=34) and age/gender-matched DED patients without HIV infection [controls (n=32)]. Participants were recruited from tertiary referral eye care centre and communicable disease clinics, Singapore. Ocular surface health was documented using tear film, Schirmer's test, corneal staining, and conjunctival injection measurements. Tear samples were collected using Schirmer's strips and analysed for the levels of 41 cytokines using Luminex bead assay. Logistic regression models were performed to determine correlation and significance.

RESULTS

Among the 41 cytokines analysed, statistically significant differences were observed in the mean values of epithelial growth factor (EGF), growth related oncogene (GRO) and interferon gamma-induced protein 10 (IP-10). EGF and IP-10 levels were higher and GRO levels were lower in the tears of DED patients with HIV infection compared to DED patients without HIV infection. No significant association was found between varying levels of ocular surface parameters and cytokine concentrations in HIV patients with DED (p>0.05).

CONCLUSIONS

EGF and IP-10 were significantly elevated and GRO levels were lower in the tear profile of HIV patients with DED compared to immunocompetent patients with DED. This study suggests a novel cytokine driven paradigm for ocular inflammatory complications of HIV infection. Additional studies in large organised cohorts can validate the results.

[Relationship between human immunodeficiency virus (HIV-AIDS) and conjunctival squamous cell carcinoma: A clinical epidemiological study of 26 cases in the ophthalmology department of the university hospital of Treichville-Abidjan (Abidjan-Côte d'Ivoire)]

PURPOSE

To describe the epidemiological and clinical parameters of conjunctival squamous cell carcinomas and their association with HIV-AIDS in the ophthalmology department of the university hospital of Treichville.

PATIENTS ET METHODS

This is a prospective and descriptive cross sectional study carried out in the ophthalmology department of the university hospital of Treichville from July 2007 to June 2011. Twenty-six (26) patients who were selected presented with a tumor of the globe and/or adnexa. A CT scan was performed in advanced cases. Histopathological examination of the surgical specimen was performed in all cases. HIV serology was performed after informed consent. All patients were referred to the oncology department of the university hospital of Treichville where a unit of care for HIV-positive patients with malignant tumors is available. Statistical analysis was performed using the software program EPI info version 6.0.

RESULTS

We note a slight predominance of female patients 15 (57.69%) vs. 11 (42.3%) male patients. The mean age was 42.32 years, and 13 patients (50%) were between 25 and 45 years of age. Intraorbital tumors were the most common reason for consultation, i.e. 38.46%. Seventeen patients (65.38%) had no particular history. Nine patients (34.61%) were already on antiretroviral treatment on admission. Three patients, i.e. 11.54%, had already had tumor biopsy and/or evisceration. The mean duration of the disease before consultation in ophthalmology was 14.28 months. Localized limbal conjunctival tumors were found in 11 cases (42.38%). Advanced tumors with regional or cerebral extension accounted for 34.61% of cases. Six patients (23.078%) were HIV negative vs. 20 (76.92%) HIV positive patients. CD4 lymphocyte typing was performed in 17 patients (85%), and 45% had a CD4 count below 200. Only five patients were able to receive neoadjuvant chemotherapy, but three of them died. The average length of follow-up was 29 months.

COMMENT

This study allowed us to establish a statistically significant link between HIV positive status of patients and the occurrence of squamous cell carcinoma, (P=10(-4)), as well as the decline in CD4 count and disease progression (p=10(-3)).

CONCLUSION

The poor prognosis of conjunctival carcinoma reflects the low socioeconomic status of patients, physician under-staffing in our health care facilities, the prohibitive cost of anticancer drugs and the link between this disease and HIV-AIDS.

[Extensive bilateral chorioretinitis revealing human immunodeficiency virus (HIV) infection]

Au cours de l'infection par le virus de l'immunodéficience humaine(VIH), Les atteintes oculaires sont polymorphes, pouvant compromettre le pronostic fonctionnel. Nous rapportons l'observation d'un patient présentant une choriorétinite infectieuse sévère révélant une infection par le VIH. Patient âgé de 35 ans avec antécédent de tuberculose pulmonaire en 2007, consulte pour BAV bilatérale progressive depuis 6 mois. Une acuité visuelle à compte les doigts au niveau de l'oeil droit et à mouvement des doigts au niveau de l'oeil gauche, avec présence de foyers choriorétiniens diffus visualisés au fond d'oeil et à l'angiographie. Les sérologies VIH, toxoplasmose et CMV sont positives. Le patient a été mis sous traitement anti-toxoplasmose (Sulfadiazine et pyriméthamine) et anti-CMV (Ganciclovir per os). L’évolution sous traitement a été marquée par une régression de la hyalite avec la persistance des foyers choriorétiniens évolutifs et une acuité visuelle réduite à perception lumineuse.

Herpes simplex keratitis-induced endophthalmitis in a patient with AIDS with disseminated tuberculosis

We present the case of a 42-year-old man with AIDS who had lost complete vision of his left eye for the past 15 days. MRI and brightness scan ultrasonography were performed on his eyes that suggested of endophthalmitis with dendritic involvement in the left eye. Viral DNA PCR was performed in aqueous humour sample that confirmed the presence of herpes simplex virus and showed a negative result for cytomegalovirus. The patient was treated with a high dose of oral acyclovir for 10 days and long-term topical acyclovir. Neodymium-doped yttrium aluminum garnet procedure was performed to clear up the cornea, and intraocular pressure was controlled with brimonidine and timolol maleate. The patient was diagnosed to have disseminated tuberculosis (tuberculoma of the brain) and was started with antituberculosis therapy. His condition improved significantly after the treatment, and keratitis in cornea started to clean up.

Reverse masquerade syndrome: fungal adnexal infection mimicking carcinoma in a HIV-positive patient

A known HIV-positive male patient presented with a rapidly progressive ulcerative lesion involving the conjunctiva, lids, and anterior orbit along with a decrease in vision in the right eye. He was on anti retro-viral and anti-tubercular therapy. In view of the clinical features, our provisional clinical diagnosis was a malignant lesion of the eyelid with orbital involvement, possibly squamous cell carcinoma. However, incisional biopsy revealed absence of malignant cells. On Gomori Methenamine Silver staining, plenty of fungal filaments were seen, which was confirmed by culture as Candida albicans. Hence, it turned out to be a case of fungal adnexal infection mimicking carcinoma in a HIV-positive patient. The patient responded well to systemic anti-fungals.

Human immunodeficiency virus and its effects on the visual system

During the first 15 years of the AIDS epidemic patients experienced a high incidence of blindness due to cytomegalovirus (CMV) retinitis and other severe ocular opportunistic infections. Highly active anti-retroviral therapy, introduced in 1996, dramatically decreased the incidence of CMV retinitis. Though CMV retinitis still causes 40% of vision loss in AIDS patients, other conditions such as immune reconstitution uveitis, cataracts, and a significant othercategory -which most investigators believe is directly due to HIV - comprise the majority of cases. HIV causes vascular abnormalities of the conjunctiva and retina in the majority of AIDS patients, as well as retinitis, anterior and posterior uveitis and vasculitis. HIV frequently causes an optic neuropathy and is responsible for the majority of eye movement disorders among HIV patients. Physicians need to be aware that these problems may be the initial manifestation of HIV infections or a sign of highly active anti-retroviral therapy (HAART) failure. Therefore, patients with identifiable risk factors for AIDS who present with ophthalmologic conditions of unknown etiology should be considered for HIV testing. Finally, anti-retroviral therapy has been reported to cause asymptomatic deposits as well as degenerative conditions of both the anterior and posterior segments of the eye.

Electron beam radiation for conjunctival squamous carcinoma

PURPOSE

To describe the authors' technique and preliminary results using electron beam radiation as rescue therapy for recalcitrant squamous cell carcinoma of the conjunctiva and cornea.

METHODS

A retrospective review comprised of an interventional case series of patients with pathologically confirmed diagnosis of squamous cell carcinoma of the conjunctiva and cornea, who had failed multiple standard treatments and underwent electron beam radiation therapy. Outcomes, radiation-related complications, and adverse effects were documented. Mortality and local control rates were calculated by the Kaplan-Meier survival probability method.

RESULTS

Eight patients met the inclusion criteria; of these, 6 (75%) were men and 2 (25%) were women, with ages ranging from 38 to 65 years (mean 50 years). One tumor (12.5%) was classified as T2N0M0, 6 (75%) were classified as T3N0M0, and one (12.5%) was classified as T4N0M0. Follow up from electron beam radiation therapy ranged from 3 to 72 months (mean 30.25 months). The most common side effect was erythema and edema of the eyelids with diffuse transient eyelash loss, seen in all patients. Tumor local control and regression after electron beam radiation therapy were noted in 6 patients (75%); recurrence was noted in 2. There was neither metastatic spread nor tumor-related deaths.

CONCLUSIONS

The authors report a small case series where local tumor control was achieved with electron beam radiation therapy for recalcitrant squamous cell carcinoma of the conjunctiva and cornea. This approach may be considered for patients who fail conventional therapy.

[Ocular complications of HIV infection: experience of the Northern Excellence Pole of Morocco]

INTRODUCTION

HIV infection is associated with a wide variety of ophthalmic manifestations. The objective of this study was to identify the ocular complications of HIV/AIDS in Morocco.

MATERIAL AND METHODS

A retrospective study conducted in the internal medicine department of the Rabat Teaching Hospital between 1998 and 2008. All HIV-positive patients were retained for the study. Each patient had an exhaustive ocular examination.

RESULTS

Of 115 ophthalmologic examinations, 28 were abnormal. Twenty-seven patients had stage C HIV infection and one patient was in stage A. The ocular manifestations were: 21 cases of ocular HIV-related anomalies (microangiopathies), four cases of cytomegalovirus (CMV) retinitis, one case of toxoplasmosis chorioretinitis, one case of CMV retinitis associated with toxoplasmosis chorioretinitis, two cases of Cryptococcus neoformans infection, two cases of varicella-zoster virus (VZV) retinitis, and one case of conjunctival Kaposi sarcoma. The CD4 count average was of 86±91/mm(3). Twenty-six patients had a CD4 count lower than 200/mm(3). Progression was favorable in 85 % of the cases, with three cases of blindness: bilateral in a case of VZV retinitis and unilateral in two cases of CMV retinitis and toxoplasmosis chorioretinitis.

CONCLUSION

CMV infection is the main ocular opportunistic infection in our series. However, Highly Active Antiretroviral Treatment (HAART) may be the cause for the decline in the prevalence of ocular diseases and visual impairment in HIV/AIDS.

Ocular Lesions Associated with Human Immunodeficiency Virus Infection

INTRODUCTION

This study was undertaken to document the various ocular manifestations in human immunodeficiency virus (HIV) infected individuals and to correlate such findings with CD4+ T lymphocyte levels in individuals with ocular manifestations.

METHODS

A total of 150 patients known to be HIV positive referred to a tertiary level army hospital were included in this cross sectional study. All patients underwent complete ophthalmic evaluation. CD4+ count was done only in patients in whom ocular lesions were noted.

RESULT

Most patients (54.66%) were in the 31-40 years age group. Majority of patients (84.66%) were males. Infection was sexually acquired in 91.33% by heterosexual mode. Majority of cases (34%) examined had presented within 12-18 months of being detected positive for HIV. Ocular involvement was present in 76 (50.66%) cases and the commonest ocular lesion encountered was cytomegalovirus (CMV) retinitis in 23 (30.26%) cases. CD4+ count less than 50 cells/µl was consistently associated with ocular manifestations in 36.84% of HIV positive patients.

CONCLUSION

This study showed the whole spectrum of ocular lesions in HIV positive cases from CMV retinitis to adnexal lesions. No case of ocular Kaposi's sarcoma was seen in this study.