Ophthalmic Manifestations of HIV Infection-A Clinical Study

Siddharth Ravishankar^*

^*Correspondence: Siddharth Ravishankar, Department of phthalmology, Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, India, Email:

Author info »

Introduction

HIV is characterized by a gradual decrease in circulating CD4+T lymphocytes and subsequent development of venous opportunistic infections and neoplasia. The role of the ophthalmologist in the diagnosis of AIDS is becoming very significant [1-4]. Not only does the eye reflect systemic disease, but ocular involvement may often precede systemic manifestations. This study aims to evaluate the venous ophthalmic manifestations in proven HIV seropositive patients and to emphasize role of ophthalmologist in the diagnosis of HIV infection.

Methodology

A group of 46 patients presented to our OPD primarily with ophthalmic complaints were included in the study. Routine clinical examination and baseline investigations including urine analysis and blood biochemical parameters were carried out.All the patients were subjected to thorough ophthalmic investigations.

Results

Cases which initially presented to ophthalmology OPD and were later found to be HIV positive had a higher incidence of Ocular complications. In this study, out of the 75 patients, 40 patients had ocular manifestations. Most common was non-infectious HIV retinopathy seen in 13 patients presenting as Cotton wool spots, retinal haemorrhages and micro aneurysms. Next common manifestation was Herpes Zoster Ophthalmicus seen in 5 patients. Non healing corneal ulcer was seen in 3 patients. A clinical diagnosis of CMV retinitis was made in three patients (Tables 1 and Table 2).

Table 1: Clinical manifestations.

Table 2: Ophthalmic manifestations.

Discussion and Conclusion

From the screened cases 41.33 patients were symptomatic with defective vision being the most common complaint. Vesicular eruptions with pain were the next common complaint in patients with HZO. A clinical diagnosis of CMV retinitis was made in three patients who presented who presented with bilateral loss of vision. Irritation was the main complaint in patients with conjunctiva microvasculopathy and pain was the main complaint in patients with orbital cellulitis. Herpes Zoster Ophthalmicus was seen 1n 5 patients. Conjunctival microvasculopathy and Retrobulbar neuritis were diagnosed in 2.66% of the patients. The role of ophthalmologists as a diagnostic clinician in HIV infection should be stressed since in this study more than 50% of the case in which we suspected HIV has proven positive on testing and follow up. These results are inn concurrence with the previous studies [4-9].

References

1. Jabs DA. Ocular manifestations of HIV infection. Transactions of the American Ophthalmological Society 1995; 93:623.
2. Trial FG. Clinical features of cytomegalovirus retinitis at diagnosis. Studies of ocular complications of AIDS research group in collaboration with the AIDS clinical trials group. Am J Ophthalmol 1997; 124:141-57.
3. Rickman LS, Freeman WR. Retinal diseases in the HIV infectd patient-Stephen Ryan 2:1571-96.
4. Freeman WR, Chen A, Henderly DE et al. Prevalence and significance or acquired immunodeficiency syndrome-related retinal microvasculopathy. Am J Ophthalmol 1989; 107:229-35.
5. Holland GN, Pepose JS, Pettit TH, et al. Acquired immune deficiency syndrome, ocular manifestations. Ophthalmology 1983; 90:85973.
6. Holland GN, Gottlieb MS, Yee RD, et al. Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome. Am J Ophthalmol 1982; 93:393-402.
7. Selliti TP, Huang AJ, Schiffman J, et al. Association of herpes zoster ophthalmicus with acquired immunodeficiency syndrome and acute retinal necrosis. Am J Ophthalmol 1993; 116:297-301.
8. Turner BJ, Hecht FM, Ismail RB. CD4+ T-lymphocyte measures in the treatment of individuals infected infected with human immunodeficiency virus type A review for clinical practitioners. Arch Intern Med 1994; 154:1561-73.
9. Young TL, Robin JB, Holland GN, et al. Herpes simplex keratitis in patients with acquired immune deficiency syndrome. Ophthalmology 1989; 96:1476-9.