Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana

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Abstract

Purpose. The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods. A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including χ 2 , independent t -test, and ANOVA were done. A p value ≤ 0.05 was considered statistically significant. Results. Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bell’s palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm3. The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders ( t = 2.5 , p = 0.012 ). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders ( t = 2.8 , p = 0.006 ). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders.

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Most cited references 31

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There is an intense interplay between HIV and the immune system, and the literature is replete with studies describing various immunological phenomena associated with HIV infection. Many of these phenomena seem too broad in scope to be attributable either to HIV-infected cells or to the HIV-specific immune response. Recently, a more fundamental understanding of how HIV affects various T cells and T cell compartments has emerged. This review covers the role of immune activation in HIV immunopathogenesis, how that activation could be mediated directly by HIV replicating within and damaging the gut mucosal barrier, how HIV affects multiple T cell functions and phenotypes, and how chronic HIV replication induces immune modulatory pathways to negatively regulate certain functions in HIV-specific T cells.

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Ocular manifestations of HIV infection.

D Jabs (1994)

To evaluate the frequency of ocular complications and the clinical outcomes of these complications in patients with various stages of HIV infection. Retrospective review of all HIV-infected patients seen in an AIDS ophthalmology clinic from November 1983 through December 31, 1992. Eleven-hundred sixty-three patients were seen for ophthalmologic evaluation. Of these, 781 had the acquired immune deficiency syndrome (AIDS), 226 had symptomatic HIV infection (AIDs-related complex [ARC]), and 156 had asymptomatic HIV infection. Non-infectious HIV retinopathy was the most common ocular complication, affecting 50% of the patients with AIDS, 34% of the patients with ARC, and 3% of the patients with asymptomatic HIV infection. Cytomegalovirus (CMV) retinitis was the most common opportunistic ocular infection, affecting 37% of the patients with AIDS. Other opportunistic ocular infections, including ocular toxoplasmosis, varicella zoster virus retinitis, and Pneumocystis choroidopathy were all much less common, each occurring in < or = 1% of the patients with AIDS. Treatment of CMV retinitis with either foscarnet or ganciclovir was successful in initially controlling the retinitis. However, relapse represented a significant problem and required frequent re-inductions. As a consequence of the retinal damage associated with relapse, loss of visual acuity occurred. The median time to a visual acuity of 20/200 or worse for all eyes with CMV retinitis was 13.4 months, and the median time to a visual acuity of 20/200 or worse in the better eye was 21.1 months. At last follow-up, 75% of the patients had a final visual acuity of 20/40 or better in at least one eye. Retinal detachments were a frequent ophthalmologic complication of CMV retinitis with a cumulative probability of a retinal detachment in at least one eye of 57% at 12 months after the diagnosis of CMV retinitis. Herpes zoster ophthalmicus developed in 3% of the overall series and was seen in all stages of HIV infection. Fifty-six percent of the cases of ocular toxoplasmosis had simultaneous toxoplasmic cerebritis. Ocular toxoplasmosis responded to standard anti-microbial therapy. Varicella zoster virus retinitis, when manifested by the acute retinal necrosis (ARN) syndrome, responded to intravenous acyclovir therapy. Conversely, in a limited number of patients with the progressive outer retinal necrosis syndrome, the disease responded poorly to intravenous acyclovir therapy, but appeared to respond to combination foscarnet and acyclovir therapy. Neuro-ophthalmic lesions were present in 6% of the patients with AIDS. The most common cause of a neuro-ophthalmic lesion was cryptococcal meningitis, and 25% of the patients with cryptococcal meningitis developed a neuro-ophthalmic complication. Ocular manifestations are common in patients with AIDS. CMV retinitis represented a major vision-threatening problem in these patients. While available therapy was successful in initially controlling the retinitis, the phenomenon of relapse resulted in some degree of long-term visual loss. Preservation of the patient's visual acuity in at least one eye was generally successful. Other opportunistic ocular infections were substantially less common than CMV retinitis but require aggressive therapy.