Ophthalmic manifestations of HIV in the highly active anti-retroviral therapy era.

West Indian Med J

Department of Surgery, Radiology Anaesthesia and Intensive Care, the University of the West Indies and University Hospital of the West Indies, Kingston 7, Jamaica.

Published: May 2014

AI Article Synopsis

  • * Many patients with eye conditions from HIV have low CD4 counts (< 200 cells/μL), and while cytomegalovirus (CMV) is a common opportunistic infection, its prevalence is lower in Africa compared to more frequent squamous cell carcinoma in that region.
  • * Highly active antiretroviral therapy (HAART) has led to fewer opportunistic infections and complications but still presents risks, including immune recovery uveitis and persistent cases of CMV retinitis in patients with

Article Abstract

HIV-related eye disease can be classified as retinal HIV microangiopathy, opportunistic infections, neuro-ophthalmic manifestations and unusual malignancies. There is a 52-100% lifetime accumulative risk of HIV patients developing eye problems. Seventy-seven per cent of patients with ocular manifestations of HIV had CD4 counts < 200 cells/μL. Cytomegalovirus (CMV) is the most prevalent opportunistic infection, however, Africa has a low incidence of this, and more commonly squamous cell carcinoma, compared to the western hemisphere. Due to highly active antiretroviral therapy (HAART), the anti-CMV therapy may be discontinued if the CD4+ T cell count is > 100 cells/μL for a minimum of three months. Despite HAART, patients with a CD4 count < 50 cells/μL have a similar risk of developing CMV retinitis as compared to the pre-HAART era. Opportunistic infections include CMV, herpetic retinopathy (progressive outer retinal necrosis - PORN), less commonly toxoplasmosis, pneumocystis and cryptococcus. Malignancies associated with HIV include Kaposi's sarcoma and conjunctival squamous cell carcinoma. Cranial nerve palsies, optic disc swelling and atrophy are characteristic neuro-ophthalmic features. They usually occur secondary to meningitis/encephalitis (from cryptococcus and tuberculosis). With the advent of HAART, new complications have developed in CMV retinitis: immune recovery uveitis (IRU) and cystoid macula oedema (CMO). Immune recovery uveitis occurs in 71% of patients if HAART is started before the induction of the anti-CMV treatment. However, this is reduced to 31% if HAART is started after the induction treatment. Molluscum contagiosum and Kaposi's sarcoma can spontaneously resolve on HAART. Highly active anti-retroviral therapy has reduced the frequencies of opportunistic infections and improved the remission duration in HIV patients.

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http://dx.doi.org/10.7727/wimj.2013.210DOI Listing

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