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

Ocular manifestations in HIV patients attending a tertiary care hospital in Eastern India and correlation of posterior segment lesions with CD4+ counts

PURPOSE

We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts.

METHODS

This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case.

RESULTS

A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30-39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001).

CONCLUSION

Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections.

Ocular manifestations of HIV and AIDS patients on antiretroviral therapy in a tertiary hospital in South Africa

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.

Ocular manifestations and refractive errors among people living with HIV in Pune, India: a cross-sectional study

Objective

We aimed to determine the ocular manifestation and refractive error prevalences among people living with HIV (PLHIV) in Pune, India.

Methods

This cross-sectional study included HIV-infected adults attending a National AIDS Research Institute clinic. Ophthalmologic examination included visual acuity estimation, refraction, orthoptic evaluation, slit lamp and fundus examination, and photography.

Results

In total, 441 HIV-infected individuals were enrolled. The participants' median age was 44 (interquartile range 38–49) years and 227 (51.5%) were men. Refractive errors occurred in 132 (29.9%) individuals. Ocular manifestations were present in 93 (21.1%) participants and the most frequent was cataract in 59 (13.4%) participants. Multivariate logistic regression analysis showed that participants who were illiterate (adjusted odds ratio [AOR] 2.80, 95% confidence interval [CI] 1.47–5.33) and those aged greater than 40 years (AOR 5.59, 95% CI 2.69–11.61) were more likely to have ocular manifestations. The odds of having ocular manifestations were greater in participants with treatment substitution or changes (AOR 2.11, 95% CI 1.16–3.82).

Conclusions

Cataract and refractive errors were prevalent among PLHIV. PLHIV should be encouraged to have regular ophthalmic checkups. Individuals with lower education levels and older age should be counseled regarding eye care and timely reporting of ocular symptoms.

Meibomian gland dropout is associated with immunodeficiency at HIV diagnosis: Implications for dry eye disease

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.