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      Vernal keratoconjunctivitis in human immunodeficiency virus – The possible role of T-helper 1–T-helper 2 shift

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          Abstract

          Human immunodeficiency virus infection (HIV) is associated with a reduced T-helper (Th) 1 response, and vernal keratoconjunctivitis (VKC) occurs secondary to a heightened Th2 response. VKC has been reported to occur in patients with HIV. In all probability, a Th1–Th2 shift occurs in the immune response in progressive HIV patients with a decreasing CD4 count. This shift could be the probable cause for the initiation and gradual worsening of the VKC in our patient that corresponded to the dropping CD4 counts. VKC resolved only after a change in antiretroviral therapy for HIV that caused a demonstrable increase in the CD4 counts possibly by reversing the shift.

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          Immunopathogenesis of ocular allergy: a schematic approach to different clinical entities.

          Andrea Leonardi, L Motterle, Chiara De Mutiis (2007)
          The immunopathogenesis of ocular allergic disorders is generally related to the specific immunoglobulin E-mediated mast cell activation and the following cascade of inflammatory mediators. Seasonal and perennial allergic conjunctivitis, however, are the only ocular diseases to involve solely type I hypersensitivity. The other main forms, vernal and atopic keratoconjunctivitis, have a more complex immunological basis and a chronic inflammatory component. Involvement of inflammatory cells, particularly eosinophils and T cells, cytokines and proteases can lead to more serious corneal damage with vision-threatening potential. Experimental allergic conjunctival models and clinical research studies have shown that T helper type 2-related mechanisms are definitely involved in the sensitization phase of ocular allergy, however, both T helper type 1 and type 2 cytokines are overexpressed in the active disease, contributing to the development of ocular inflammation. A review of the recent literature allows us to better understand the mechanisms involved in the development of ocular allergy and to guide us toward a more schematic approach, which could possibly be useful in forming a new classification, standardizing clinical phases and individuating new treatment targets.
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            Ocular manifestations of HIV infection.

            Todd P. Margolis, Francesca Cunningham (1998)
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              Anterior segment and external ocular disorders associated with human immunodeficiency virus disease.

              Bennie H Jeng, Gary N Holland, Careen Y. Lowder … (2015)
              The eye is a common site for complications of human immunodeficiency virus (HIV) infection. Although cytomegalovirus retinitis remains the most prevalent of the blinding ocular disorders that can occur in individuals with the acquired immunodeficiency syndrome (AIDS), several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae. Some of these entities, such as Kaposi sarcoma, were well described, but uncommon, before the HIV epidemic. Others, like microsporidial keratoconjunctivitis, have presentations that differ between affected individuals with HIV disease and those from the general population who are immunocompetent. The treatment of many of these diseases is challenging because of host immunodeficiency. Survival after the diagnosis of AIDS has increased among individuals with HIV disease because of more effective antiretroviral therapies and improved prophylaxis against, and treatment of, opportunistic infections. This longer survival may lead to an increased prevalence of anterior segment and external ocular disorders. In addition, the evaluation and management of disorders such as blepharitis and dry eye, which were previously overshadowed by more severe, blinding disorders, may demand increased attention, as the general health of this population improves. Not all individuals infected with HIV receive potent antiretroviral therapy, however, because of socioeconomic or other factors, and others will be intolerant of these drugs or experience drug failure. Ophthalmologists must, therefore, still be aware of the ocular findings that develop in the setting of severe immunosuppression. This article reviews the spectrum of HIV-associated anterior segment and external ocular disorders, with recommendations for their evaluation and management.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Ophthalmol
                Journal ID (iso-abbrev): Indian J Ophthalmol
                Journal ID (publisher-id): IJO
                Title: Indian Journal of Ophthalmology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0301-4738
                ISSN (Electronic): 1998-3689
                Publication date (Print): July 2018
                Volume: 66
                Issue: 7
                Pages: 1004-1006
                Affiliations
                [1]CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic For Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
                [1 ]Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
                [2 ]Department of Paediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India
                Author notes
                Correspondence to: Dr. Bhaskar Srinivasan, CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic For Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu, India. E-mail: drbhaskar@ 123456hotmail.com
                Article
                Publisher ID: IJO-66-1004
                DOI: 10.4103/ijo.IJO_76_18
                PMC ID: 6032743
                PubMed ID: 29941754
                SO-VID: aa07c0b0-268d-4635-a69e-9ced340a687b
                Copyright © Copyright: © 2018 Indian Journal of Ophthalmology
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 15 January 2018
                Date accepted : 15 April 2018
                Categories
                Subject: Case Reports

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: allergic conjunctivitis,human immunodeficiency virus,vernal keratoconjunctivitis
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: allergic conjunctivitis, human immunodeficiency virus, vernal keratoconjunctivitis

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