The socioeconomic impact of human immunodeficiency virus / acquired immune deficiency syndrome in India and its relevance to eye care

Prevalence and Associated Factors of Ocular Manifestations of Acquired Immune Deficiency Syndrome Among Adults at University of Gondar Hospital, North West Ethiopia, 2021

Introduction

Acquired immune deficiency syndrome is a disease with common clinical ocular manifestations. Ocular manifestations lead to blindness, which has a common social and economic impact.

Purpose

This study aimed to assess the prevalence and associated factors of ocular manifestations of acquired immune deficiency syndrome among adults at the University of Gondar Hospital, North West Ethiopia, 2021.

Patients and Methods

A cross-sectional study was conducted on 401 patients from June to August 2021. Samples were selected based on a systematic random sampling technique. Data collection was done using structured questionnaires. Data extraction format was used to collect the clinical characteristics of patients including ocular manifestations. Data entry was done by EpiData version 4.6.0.6 and exported to the Statistical Package for the Social Sciences version 26 for data analysis. Associated factors were analyzed by binary logistic regression. P-value <0.05 with a 95% confidence level was used to declare a significant association.

Results

A total of 401 patients were involved with a response rate of 91.5%. The overall prevalence of ocular manifestations of acquired immune deficiency syndrome was 28.9%. The common ocular manifestations were seborrheic blepharitis at 16.4% and squamoid conjunctival growth at 4.5%. Age >35 years (AOR=2.52, 95% CI: 1.19, 5.35), Clusters of differentiation 4 count <200 cells/µL (AOR=4.76, 95% CI:2.50, 9.09), World Health Organization stage II (AOR=2.60, 95% CI: 1.23, 5.50), history of eye disease (AOR=3.05, 95% CI: 1.38, 6.72), and duration of Human Immunodeficiency Virus >5 years (AOR=2.79, 95% CI: 1.29, 6.05) were statistically associated with the ocular manifestation of acquired immune deficiency syndrome.

Conclusion and recommendations

In this study, the prevalence of ocular manifestation of acquired immune deficiency syndrome was high. Age, CD4 count, duration of HIV, eye disease history, and WHO clinical staging were the significant factors. Early eye checkups and regular ocular examinations of HIV patients would be helpful.

Ocular manifestation and their associated factors among HIV/AIDS patients receiving highly active antiretroviral therapy in Southern Ethiopia

AIM

To assess the pattern of ocular manifestation and associated factors among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART) at Hawassa University Referral Hospital, Southern Ethiopia.

METHODS

A cross sectional study was conducted from January 2014 to April 2015. After obtaining informed written consent, 240 adult HIV/AIDS patients on HAART were randomly selected regardless of their ophthalmic symptoms, WHO status or CD4 count. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 20.0 software.

RESULTS

The mean duration of HAART was 62.5mo. The prevalence of HIV related ocular manifestation was 14.2%. Seborrheic blepharitis (5%) was the most common ocular manifestation, followed by squamoid conjunctival growth (3.8%). The rate of ocular manifestation was significantly higher among study participants who had CD4+ count <200 cells/µL (AOR=3.83; 95%CI: 1.315-11.153), low duration of HAART (AOR=3.0; 95%CI: 1.305-6.891) and who had primary school education [odds ratio (OR) =2.8; 95%CI: 1.105-7.099]. Prevalence of visual impairment and blindness was 10.9% and 5.8%, respectively.

CONCLUSION

HAART may be the reason for the decline in the prevalence of ocular manifestation in HIV/AIDS patients in the study area. Ophthalmologic screening of HIV/AIDS patients, especially those with CD4 counts of <200/µL cells and in the first five years of HAART follow-up is recommended to reduce visual impairment and/or blindness.

Prevalence of HIV-associated ophthalmic disease among patients enrolling for antiretroviral treatment in India: a cross-sectional study

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.