Mallika Goyal, MD (Hyderabad, India), B. Balaraju, MD (Hyderabad, India), K. V. Emmanuel, MD (Hyderabad, India), Geeta V. Narayanan, MD (Hyderabad, India)

PURPOSE:

According to estimates from the UNAIDS/ WHO, 38 million adults and 2.3 million children were living with HIV/AIDS at the end of 2005. Aggressive management and multidisciplinary approach has prolonged the survival of patients with HIV/AIDS. Understanding the clinical spectrum of visually threatening ophthalmic manifestations, early detection and appropriate
management may help add “light to life.”

METHODS:

This was a nonrandomized prospective interventional case series including 1.000 consecutive patients with HIV/AIDS screened for posterior segment manifestations and treated between January 2003 and December 2005. We included all patients with HIV/AIDS diagnosed by reactive screening test for HIV antibody by ELISA, with specific antibody identified by Western Blot, and laboratory and clinical criteria specified by the CDC Revised Classification System for HIV Infection and Expanded AIDS Surveillance Case Definition for Adolescents and Adults. The study was conducted in three major HIV/AIDS treatment centers in Hyderabad in Southern India and the data were pooled and analyzed.

RESULTS:

The mean patient age was 28.4 years. In all, 22% patients had visual symptoms. 62 (6.2%) had visual acuity <20/200 in the better eye. 40 (4%) had NLP in one eye and 6 (0.6%) NLP in both eyes. 189 (18.9%) patients had microvascular abnormalities – cotton wool spots, retinal hemorrhages capillary nonperfusion, neovascularization, and vascular occlusion. Manifestations related to opportunistic infections (163, 16.3%) comprised of CMV retinitis (146, 14.6%), ARN (8, 0.8%), toxoplasma retinochoroiditis (6, 0.6%), choroidal tuberculosis (2, 0.2%) and 1 each of PORN, candida endophthalmitis, and cryptococcus chorioretinitis. 8 (0.8%) showed noninfectious neuroophthalmic affections. Choroidal lymphoma (2, 0.2%) and retinovitreal lymphoma (1, 0.1%) were rare. Management included multi-system screening, HAART therapy, and specific therapy for treatable ophthalmic manifestations. Visual acuity improved in 135 of 150 (90%) eyes which underwent treatment and deteriorated in 15 (10%).

CONCLUSION:

A significant proportion of patients with HIV/AIDS have visually significant posterior segment manifestations, a majority of which are comprised of retinal microvascular abnormalities and opportunistic infections. Mandatory screening and periodic ophthalmic evaluation may help in early diagnosis. Prompt institution of HAART therapy and specific ocular treatment provides gratifying visual outcome.