Ocular association of HIV infection in the era of highly active antiretroviral therapy and the global perspective

Abstract

Ocular involvement is a common complication of HIV infection. Since the late 1990s, widespread use of highly active antiretroviral therapy (HAART) has altered the spectrum, and reduced the incidence of ocular involvement in developed countries. The incidence of the most common ocular opportunistic infection, cytomegalovirus retinitis, has decreased tremendously. However, immune recovery uveitis secondary to HAART has emerged as a frequent visually threatening condition. Early diagnosis and treatment with periocular steroids is helpful in minimizing visual loss. Clinicians should also be aware that certain antimicrobial agents used to treat opportunistic infections in HIV-positive patients are associated with potentially serious ocular side effects. In developing countries, where most of the world's 40 million HIV-positive patients live, the spectrum and incidence of ocular involvement differ from those in developed countries. The lack of HAART availability is among the many causes of these differences, which may include nutritional factors, basic medical care availability and the levels of exposure to different infectious agents. These factors add to the already challenging task of treating ocular complications and preventing blindness in HIV-positive patients in developing countries.

Infectious Uveitis in Immunocompromised Patients and the Diagnostic Value of Polymerase Chain Reaction and Goldmann-Witmer Coefficient in Aqueous Analysis

“…25 Overall, we found no significant difference in the frequency of CMV retinitis between patients with AIDS and nonAIDS patients (Table 2). However, since the introduction of highly active antiretroviral therapy (HAART), which has been reported to result in a considerable decline of disseminated and ocular CMV infections in patients with AIDS, 24,26,27 no new cases of CMV retinitis were observed in our patients with AIDS. Indeed, comparison of the incidence of CMV retinitis in patients with AIDS and nonAIDS patients before and after the introduction of HAART in The Netherlands in 1997 revealed a significant difference after the introduction of HAART (P ϭ .002).…”

“…[3][4][5]23,24 However, little is known about the etiology of uveitis in patients immunocompromised other than by AIDS. 25 Overall, we found no significant difference in the frequency of CMV retinitis between patients with AIDS and nonAIDS patients (Table 2).…”

HIV-1 gp120 Glycoprotein Interacting with Dendritic Cell-specific Intercellular Adhesion Molecule 3-grabbing Non-integrin (DC-SIGN) Down-Regulates Tight Junction Proteins to Disrupt the Blood Retinal Barrier and Increase Its Permeability

“…For instance, cytomegalovirus, varicella-zoster virus and herpes simplex virus have been described as the most common causes for retinitis, iridocyclitis, keratitis, and other ocular diseases in HIV-1 patients (13,16,17). In a cross-sectional study of 787 cases of HAART-treated HIV-1 patients in eastern China, we have found the prevalence of ocular complications to be 26.3%; among them, cytomegalovirus retinitis had the highest prevalence (10.6%), followed by ocular microangiopathy (9.4%) (15).…”

Effect of highly active antiretroviral therapy (HAART) on the natural history of ocular manifestations in HIV-infected children

“…[1][2][3][4] However, the introduction of highly active antiretroviral therapy (HAART) has led to a considerable decline in opportunistic infections and a reduction in HIV-related deaths. 5,6 All of the available reports concerning ocular involvement in HIV-infected patients in the HAART era relate to adults; [7][8][9][10] no childhood data are available. The aim of this study was to determine the effect of HAART on the natural history of ocular manifestations in HIV-infected children.…”