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Cytomegalovirus retinitis in a patient with HIV. Arrows point towards extensive area of retinal necrosis. Also visible is the typical frosted branch angitis appearance of the vessel.
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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 Ind...
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Citations
... The median CD4 T-cell count in our study was 67 cells/mm 3 and was much lower than the average CD4 T-cell count of 126 cells/ mm 3 in HIV patients who presented without visual manifestations indicating a poor immune status. 1 A statistically significant negative correlation has been seen between ocular manifestations and CD4 T-cell count. 7,9 Before the advent of ART, CMV retinitis was the commonest ocular manifestation in developed countries affecting 30-40% of HIV infected individuals. Though its incidence has declined significantly after the advent of successful treatment it still remains the commonest cause of visual impairment in HIV patients. ...
... We have included two cases of CMV retinitis in descriptive analysis whose CD4 counts were 58 and 108 cells/mm 3 , respectively which is in concordance with the observations of Sharma et al. who reported a significant inverse association of CMV retinitis and CD4 T-cell counts. 7 In Africa, CMV retinitis is less common with prevalence rates ranging from 0 to 8.5%. 8,10 Ocular findings in the case of visual acuity loss were the destruction of retinal tissue in the posterior pole ranging from 54 to 84% of cases and retinal detachment ranging from 26 to 63% of cases. ...
... patients out of a total of 125 HIV-positive patients. Similar incidence rate of 35.3% was reported by Sharma et al. [17] in their study conducted on 150 HIV-positive patients. However, a slightly higher incidence rate of 40% was reported by Singh et al. [18] The higher incidence rate in the study could have been due to the lesser number of patients (76) enrolled in the study. ...
... Sharma et al. [17] (2018) (n=150) Narasimhaiah et al. [ ...
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.
... Numerous studies have been carried out to study the prevalence of ocular manifestations in HIV positive patients, which is found to be around 40-70%. [3] (Table 4) Mukta Sharma et al [23] conducted a similar cross-sectional study on 150 confirm HIV positive patients on HAART,51.3% Patients were having CD4 T cell count above 200 cells/µl. ...
Introduction:AIDS is a multisystem disease, which can affect any part of the eye& can lead to significant morbidity and mortality. Around 40-70% of patients with HIV infection develops one of the ocular manifestations during lifetime. Introduction of HAART had significantly reduced occurrence of opportunistic infections and neoplasia in these patients. Purpose:This study was conducted to study various ocular manifestations in HIV patients and to find out their prevalence and correlation with CD4 T Cell count. Material & Methods:We conducted a Cross-Sectional Study on 100 confirmed HIV patients taking HAART. We conducted detailed ocular examination of these patients including vision assessment, IOP measurement, slit lamp examination and fundus examination. CD4 T Cell count and Duration of the Disease was also noted. Results:We found 52% prevalence of HIV related ocular manifestations. Anterior Segment manifestations were more common than Posterior Segment. Dry Eye was the most common ocular finding accounting for 44.23% of the patients with ocular manifestations. Other Anterior Segment diseases included Cataract, Conjunctival Microvasculopathy, Blepharitis, Stye, Pterygium, Allergic Conjunctivitis, Anterior Uveitis and Viral Keratitis. Only 7 patients had Posterior Segment Diseases. 1 patient each of CMV Retinitis and PORN was seen, both having CD4 T Cell count below 100 cells/µl. Occurrence of these ocular manifestations were not related to age & gender of the patient or to the duration of the disease. Conclusions:All patients with HIV should undergo Ophthalmic examination, irrespective of the CD4 T Cell count, Duration of Disease or presence of symptoms. Screening help in detecting these ocular diseases at early stage and thereby with early initiation of appropriate treatment help in reducing the visual morbidity.
... Eighty-five of the 318 patients studied (26.7%) had various manifestations of the retina and vitreous which was similar to different local studies which ranged from 14% to 60%. [4,[14][15][16][17][18][19] Posterior segment manifestations of HIV/AIDS has been documented in literature and typically classified into four major groups namely vasculopathy, opportunistic infections, unusual malignancies, and neuro-ophthalmologic abnormalities. [11,20] Posterior segment lesions in our study were distributed into all the groups with the exception of unusual malignancies. ...
Background: The human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a multi-systemic disease with known manifestations involving all ocular structures from the orbit and ocular adnexa, anterior segment to the retina and vitreous. Some of these manifestations including cytomegalovirus (CMV) retinitis and HIV retinopathy are HIV/AIDS-defining illnesses. The aim of this study is to determine the vitreoretinal manifestations in patients with HIV/AIDS attending an antiretroviral therapy clinic in Nigeria. Methods: This was a prospective, cross-sectional study of consenting, confirmed HIV/AIDS patients attending an antiretroviral therapy clinic in Nigeria. All willing, consecutive patients who gave an informed consent were recruited. Sociodemographic data and clinical information were collected with the use of a structured interviewer–administered questionnaire. Best-corrected visual acuity was recorded. Anterior segment and ocular adnexa examination was performed with a pen torch. Detailed anterior and posterior segment examination was performed with slit lamp biomicroscopy with Volks +78 diopter lens and binocular indirect ophthalmoscopy. The data were analyzed with SPSS (statistical package for social sciences) version 16. Ethical approval was obtained from the institutional ethics committee. Results: Three hundred and eighteen patients were studied of which 85 (26.7%) had disorders affecting the retina and vitreous. The female-to-male ratio was 2:1. More than a third of patients (38.7%) were in the 40–49 years of age group and the mean age was 47.2 years. The most common vitreoretinal lesion was presumed ocular toxoplasmosis present in 9.7% of all respondents. This was closely followed by HIV retinopathy in 3.5%, ocular tuberculosis in 1.8%, and CMV retinitis in 1.6% respondents. Two hundred and seventy-seven (87.1%) respondents were on highly active antiretroviral therapy and 41 (12.9%) were not on treatment. Conclusion: A high prevalence of ocular conditions especially those affecting the retina and vitreous exists in patients with HIV/AIDS attending the antiretroviral therapy clinic in a tertiary hospital in Nigeria. Regular eye examinations are recommended for these patients to prevent potentially visual debilitating disorders.
... 7 La afectación ocular es frecuente en pacientes con VIH. 8 Holland et al. fueron los primeros en reportarlas y todos los casos tanto vivos como en autopsias que exploraron presentaron anormalidades oculares. 3 Hodge et al. determinaron que no todas las infecciones oculares en pacientes con VIH son oportunistas. ...
Background:
Since the first cases of human immunodeficiency virus (HIV), ocular manifestations secondary to infection have been known and these have been related to the CD4+ lymphocyte count.
Objective:
To describe the correlation between ocular manifestations in patients with HIV and the CD4+ lymphocyte count.
Material and methods:
Analytical cross-sectional study of patients with HIV whose CD4+ count was correlated with the presence of ophthalmological manifestations.
Results:
21 patients between 26 and 67 years were studied. Only 3 patients were not on antiretroviral therapy. 67% of the patients presented some type of ocular manifestation, 42% presented non-infection related manifestations, 47% related manifestations and 24% both. Conjunctival microangiopathy was the most frequent ocular manifestation (35.7%). There was a statistically significant correlation (r = 0.76, p = 0.0001) between eye manifestations related to infection and CD4+ lymphocyte count.
Conclusions:
Patients with HIV frequently present ocular manifestations, the majority related to infection; there is a correlation between the presence of these with the CD4+ count. However, a similar number of manifestations not related to infection occurred without correlation with the count; therefore, HIV patients should have periodic ophthalmological examinations, independently of CD4+ count.
... The lifetime risk of having at least one abnormal ocular lesion amongst HIV and AIDS individuals ranges from 52% to 100%. 15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30 The results of this study showed that 72.3% of HIV and AIDS participants seen at Steve Biko Academic Hospital had ocular lesions or disorders. In this study, 89 (50.3%) belonged to the economically productive age group of 31-50 years. ...
... This finding is consistent with the general facts of immunosuppression where a CD4+ count less than 200 is a predictor of ocular disorders in HIV and AIDS patients. 19,20,21,22,23,24,25,26,27,28,29,30 Participants who had a low duration on HAART showed higher occurrence of ocular disorders compared to those with more than five years. This could be as a result of the longer use of ART drugs increasing the CD4+ cell counts, boosting the immune system and reducing the occurrence of opportunistic infections. ...
... 21,23 Neuro-ophthalmic manifestations such as papilloedema, optic neuritis and optic atrophy are some known disorders to occur in HIV and AIDS patients. 19,20,21,22,23,24,25,26,27,28,29,30 In this study, 30 (16.9%) of the participant had neuro-ophthalmic lesions. The findings of this study were higher than those reported by Sudharshan et al. (8.9%), Biswas et al. 22 (9.3%), ...
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.
... Various reports have shown that ocular manifestations commonly occur among HIV-infected individuals in India. [11][12][13][14][15] In the present study, most participants were receiving ART and the overall prevalence of ocular manifestations was 21.1%. Sight-threatening ocular morbidity in our study was lower than what has been cited in other reports from India. ...
... Sight-threatening ocular morbidity in our study was lower than what has been cited in other reports from India. 3,[11][12][13][14][15] The relatively lower prevalence of sight-threatening morbidities in our study might be owing to differences in the study design, duration of ART, and CD4 count at study initiation. A study by Karnataka reported a prevalence of 37.6% among HIV-infected individuals in an ART center where PLHIV with ocular complaints were referred to an ophthalmology clinic for treatment. ...
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.
... While much attention has been placed on posterior eye dysfunction in HIV-infected individuals, relatively few studies have specifically characterized anterior segment and external ocular disorders, which can still affect one-third of individuals with HIV in the era of ART [10][11][12]. The most common anterior segment manifestation is dry eye disease, which affects approximately 10% of people with HIV [10]. ...
... The most common anterior segment manifestation is dry eye disease, which affects approximately 10% of people with HIV [10]. Whilst previous epidemiological studies have broadly reported on the prevalence of anterior ocular health conditions amongst individuals living with HIV [10,11], a comprehensive and quantitative characterization of anterior ocular health in individuals on stable ART is currently lacking. In the present study, we sought to investigate whether people who have HIV infection, effectively managed with ART and without current symptomatic eye disease, demonstrate anterior eye abnormalities. ...
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.
... HIV retinopathy was seen in 21 (81%) of the patients with CD4 count <50 cells/cubic millimeter, 8 (67%) with CD4 count 51-100 cells/cubic millimeter and 38 (27%) patients with CD4 count between 101-150 cells/cubic millimeter (P<0.001). This was earlier proved by Sahu DK et al, Gogri PY et al, Sharma RL et al, Nihijima T et al, Sharma M et al, whereas Kumar P et al, had found CMV retinitis as most common manifestation.6-11 CMV retinitis was seen in 3 (12%) of patients with CD4 count <50 cells/cubic millimeter, 1 (8%) with CD4 count 51-100 cells/cubic millimeter, 5 (4%) with CD4 count 101-150 cells/cubic millimeter. ...
Background: Ocular manifestations of HIV infections are common in the developing countries with lacking data in rural areas. The aim of study was to assess the prevalence of ophthalmic manifestations among HIV infected individuals in rural population and to find the relationship between CD4 count and ocular manifestations among these individuals.Methods: Authors have included 400 HIV patients of age more than 15 years that were registered in ART center of our institute. Ocular examination was done with slit lamp biomicroscope and indirect ophthalmoscope. Blood sample was sent for CD4 count analysis.Results: The mean age of patients ware 31.9±9.3 years, the ocular manifestations were more commonly found in the age group 25-35 years. 51 % were males and 49% were females. Most common mode of transmission was heterosexual contact (51%).55 % patients had CD4 count >150 cell/cumm. Cotton wool spots (36%) and intra-retinal haemorrhages (32%) was most common posterior segment findings followed by ocular toxoplasmosis (13%), CMV retinitis (10%), acute retinal necrosis (3 %).Conclusions: The prevalence of ocular manifestations in HIV patients is high and is a burden for our society, authors recommend screening of all the HIV patients to detect any vision threatening ocular lesions at the earliest.
Background: Ocular manifestation of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) affects various ocular structures including the anterior segment and ocular adnexae and may be a cause of ocular morbidity. The aim of the study is to determine the pattern of lesions affecting the anterior segment and ocular adnexae in patients diagnosed with HIV/AIDS whether on highly active antiretroviral therapy or not and confirmed positive for retroviral disease by western blot attending an antiretroviral therapy clinic in Southwestern Nigeria. It is a prospective, cross-sectional study on anterior segment and ocular adnexae lesions in patients with HIV/AIDS. Materials and Methods: A total of 318 consecutive patients with the confirmation of a diagnosis of HIV/AIDS attending the antiretroviral therapy clinic within the study period from 2009 to 2010 had visual acuity evaluation, a detailed ocular examination by slit-lamp biomicroscopy, and binocular indirect ophthalmoscopy. The data generated were analysed using SPSS (Statistical Package for the Social Sciences) version 16. Ethical clearance was obtained from the hospital research ethics committee. Results: Two hundred and ninety-five (92.8%) patients of the 318 recruited had anterior segment manifestations, whereas ocular adnexal lesions were present in 134 (42.1%) patients. Multiple ocular pathology of the anterior segment and ocular adnexal was present in some of the respondents recruited. There were more female respondents. One hundred and twenty-three patients (38.7%) recruited for the study were in the 40–49 years of age group with a mean age of 47.2 years (SD = 9.42 years). The most common anterior segment lesion was corneal opacity in 18 patients (5.6%), and the most common ocular adnexal lesion was pingueculum in 56 respondents (17.6%). Other HIV/AIDS-associated adnexal lesions present include hypertrichosis in 25 patients (7.9%), herpes zoster ophthalmicus (HZO) in 13 (4.1%), and squamous cell carcinoma of the conjunctiva in 4 (1.3%) patients. The most common HIV-associated anterior segment pathology was HZO-associated keratouveitis seen in four patients (1.3%) and herpes simplex keratitis in one patient (0.3%). Conjunctival microangiopathy was the most common HIV-associated ocular adnexal lesion. The relationship between viral load values and lesions involving both anterior segment and ocular adnexal disease was statistically significant as these patients tended to have higher viral loads when compared with those without lesions (P < 0.05). Conclusion: Anterior segment and ocular adnexal lesions were frequent in patients with HIV/AIDS attending a tertiary health institution in urban Nigeria. HIV/AIDS-defining ocular illnesses including HZO, conjunctival microangiopathy, and ocular surface squamous cell neoplasia are not uncommon in these patients. Potentially debilitating ocular disorders may be avoided by instituting periodic ocular examinations.
