Ophthalmic manifestations of HIV in the highly active anti-retroviral therapy era.

Abstract

HIV-related eye disease can be classified as retinal HIV microangiopathy, opportunistic infections, neuro-ophthalmic manifestations and unusual malignancies. There is a 52-100% lifetime accumulative risk of HIV patients developing eye problems. Seventy-seven per cent of patients with ocular manifestations of HIV had CD4 counts < 200 cells/μL. Cytomegalovirus (CMV) is the most prevalent opportunistic infection, however, Africa has a low incidence of this, and more commonly squamous cell carcinoma, compared to the western hemisphere. Due to highly active antiretroviral therapy (HAART), the anti-CMV therapy may be discontinued if the CD4+ T cell count is > 100 cells/μL for a minimum of three months. Despite HAART, patients with a CD4 count < 50 cells/μL have a similar risk of developing CMV retinitis as compared to the pre-HAART era. Opportunistic infections include CMV, herpetic retinopathy (progressive outer retinal necrosis - PORN), less commonly toxoplasmosis, pneumocystis and cryptococcus. Malignancies associated with HIV include Kaposi's sarcoma and conjunctival squamous cell carcinoma. Cranial nerve palsies, optic disc swelling and atrophy are characteristic neuro-ophthalmic features. They usually occur secondary to meningitis/encephalitis (from cryptococcus and tuberculosis). With the advent of HAART, new complications have developed in CMV retinitis: immune recovery uveitis (IRU) and cystoid macula oedema (CMO). Immune recovery uveitis occurs in 71% of patients if HAART is started before the induction of the anti-CMV treatment. However, this is reduced to 31% if HAART is started after the induction treatment. Molluscum contagiosum and Kaposi's sarcoma can spontaneously resolve on HAART. Highly active anti-retroviral therapy has reduced the frequencies of opportunistic infections and improved the remission duration in HIV patients.

• Authors: L Mowatt
• Journal: The West Indian medical journal (West Indian Med J) Vol. 62 Issue 4 Pg. 305-12 ( 2013) ISSN: 0043-3144 [Print] Jamaica
• PMID: 24756590 (Publication Type: Journal Article)

Chemical References

• Anti-HIV Agents
• Antiviral Agents

Topics

• AIDS-Related Opportunistic Infections (etiology)
• Anti-HIV Agents (therapeutic use)
• Antiretroviral Therapy, Highly Active (methods)
• Antiviral Agents (therapeutic use)
• CD4 Lymphocyte Count
• Carcinoma, Squamous Cell (etiology)
• Conjunctival Neoplasms (etiology)
• Cytomegalovirus Retinitis (etiology, prevention & control)
• Eye Diseases (etiology)
• Eye Neoplasms (etiology)
• HIV Infections (complications, drug therapy)
• Humans
• Optic Nerve Diseases (etiology)
• Retinal Diseases (etiology)
• Sarcoma, Kaposi (etiology)
• Vascular Diseases (etiology)