Ocular lesions in 1,000 consecutive HIV-positive patients in India: a long-term study

Abstract

BackgroundOcular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern. Although they have been described in the Western population, there are not many such studies in the HAART era from India. This study aims to present the clinical profile, systemic correlation, and visual outcome in HIV-positive patients in relation to HAART in comparison with pre-HAART Indian studies and current Western data. Ocular findings and systemic correlation in 1,000 consecutive patients with HIV seen at a tertiary eye care center were analyzed. This study uses a prospective observational case series design.ResultsAge range of the patients was 1.5 to 75 years. Ocular lesions were seen in 68.5% of the patients (cytomegalovirus (CMV) retinitis was the commonest). The commonest systemic disease was pulmonary TB. Mean interval between HIV diagnosis and onset of ocular lesions was 2.43 years. CD4 counts range from 2 to 1,110 cells/mm3. Immune recovery uveitis (IRU) was seen in 17.4%. Interval between HAART initiation and IRU was 4 months to 2.5 years. Recurrence of ocular infection was seen in 2.53% (post-HAART) and > 20% (pre-HAART). Overall visual outcome showed improvement in about 14.3% and was maintained in 71.6% of the patients.ConclusionsCMV retinitis is the commonest ocular opportunistic infection in India, even in the HAART era. Newer manifestations of known diseases and newer ocular lesions are being seen. In contrast to Western studies, in our patients on HAART, ocular lesions do not always behave as in immunocompetent individuals. Ocular TB needs to be kept in mind in India, as well as other neuro-ophthalmic manifestations related to cryptococci, especially in gravely ill patients. Occurrence and frequency of various ocular opportunistic infections in developing nations such as India have significant variations from those reported in Western literature and need to be managed accordingly.

Ocular Manifestations of Hiv/Aids Among Patients Receiving Highly Active Antiretroviral Therapy in a Tertiary Care Centre

“…(14) have found lesser frequency of anterior segment manifestation as compared to posterior segment manifestations with 10% of patients having anterior segment inflammation.…”

Uveitis causes according to immune status of patients

“…; Sudharshan et al. ). Our data shows that CMV retinitis occurred in the majority of our patients with HIV infection (usually in newly diagnosed patients with acquired immunodeficiency syndrome or treatment failures).…”

Bevacizumab for paradoxical worsening treatment adjunct in HIV patient with choroidal tuberculoma

“…Ocular TB may cause features of anterior or posterior uveitis, amongst which tubercle granuloma is the commonest presentation [1, 2]. ATT is often initiated along with ART to treat the disease, following which most of the patients improve, but some patients may develop paradoxical reactions to therapy [3].…”

“…It can occur in the form of anterior or posterior uveitis, most commonly in the form of choroidal granulomas [1, 2]. We initiate anti-tubercular therapy (ATT) and anti-retroviral therapy (ART), following which most of the patients improve but some may develop paradoxical reactions to this therapy.…”