Ocular manifestations of HIV/AIDS

Abstract

HIV/AIDS affects millions of people worldwide. In the early stages of epidemic, eyes were affected because the CD4 T-lymphocytes count of HIV-infected patients dropped rapidly. Today, with the advent of highly active antiretroviral therapy, HIV-positive individuals live longer with a better quality of life. However, because a cure has not been found, many patients with HIV will develop ocular complications at some point. Ophthalmologists play an important role in the care of these patients. We must be prepared to work as part of a multidisciplinary staff, helping to understand the causes and try to achieve the best management of disease in order to prevent blindness. Most HIV-related ocular manifestations are discussed in this article, with a review of studies within the past 2 years. We hope government authorities, pharmaceutical industries, researchers and people from all nations stand together with two goals--less suffering and definitive cure.

What you can see in your patient's eyes? Review of ocular manifestations of HIV in HAART era

“…5,19 Symptoms like floaters, photopsia and reduced visual acuity and visual field defect should be sought in high-risk patients with suggestive history of CMV retinitis. 5,21 Varicella zoster virus (VZV) and herpes simplex virus (HSV) are other keratotrophic members of this family and are the most common causes of interstitial keratitis in HIV-positive patients. 5,6 They can also involve the retina and are believed to be responsible for most of the reported cases of acute retinal necrosis (ARN), 22 which may occur at any levels of CD4 counts.…”

“…2 Suboptimal pathogen-specific immune response, however, can complicate the management of some patients even after HAART and a significant increase in CD4 T-lymphocyte count. 21 Prior to advent of HAART, patients with CMV retinitis would suffer progression within a median of 3 weeks without specific anti-CMV therapy. 2 This would be delayed up to 3-4 months in patients receiving systemic anti-CMV therapy.…”

Adnexal and Anterior Segment Manifestations of HIV/AIDS

“…Afflicted HIV-positive individuals are more susceptible to bacterial keratitis, demonstrate decreased tear meniscuses, diminished Schirmer responses, and interpalpebral staining with Rose bengal dye, and have tear composition abnormalities including lysozymal and osmolar anomalies. [28][29][30] Some individuals may also have ''Sjogren-like syndrome,'' which is characterized by salivary gland enlargement and xerostomia in addition to the dry eyes. 31 Prevailing theories of pathogenesis implicate HIV itself as the inflammatory mediator that destroys primary and accessory lacrimal glands; direct infection and damage to the conjunctiva may also be involved.…”

“…79 Only a handful of cases of ''spontaneous'' bacterial ulcerative keratitis have been reported in HIV/AIDS patients, with Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa most frequently implicated. 28 Klebsiella oxytoca, Streptococcus, Bacillus, Micrococcus, Capnocytophaga, and most recently Acanthameba species have also been shown to cause disease, with some cases of recalcitrant infection requiring keratoplasty and even evisceration of the globe. [80][81][82] It has been theorized that HIV-infected hosts may be predisposed toward these spontaneous bacterial keratitides because of preexisting KCS and viral keratitis, which create corneal epithelial erosions that allow for subsequent bacterial entry.…”

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.…”