title: Sicca syndrome in patients infected with the human immunodeficiency virus.
abstract: OBJECTIVE
  To investigate an association of the severity of the human immunodeficiency virus (HIV) disease with decreased tear production in a controlled setting.
  
  
  METHODS
  Seventy-two patients (144 eyes) and 30 age- and sex-matched control subjects (60 eyes) were studied prospectively. Tear production was measured using the Schirmer I test (measured in millimeters after 5 minutes). Patients were classified into three clinical groups: asymptomatic HIV infection, lymphadenopathy syndrome (LAS) or acquired immune deficiency syndrome (AIDS)-related complex (ARC), and AIDS. Additionally, patients were classified according to the CD4+ lymphocyte count.
  
  
  RESULTS
  Tear production (mean +/- standard deviation) did not differ (P = 0.32) among eyes of patients with asymptomatic HIV infection (17.1 +/- 10.8; n = 14), LAS or ARC (18.3 +/- 10.3; n = 70), and AIDS (20.7 +/- 10.3; n = 60). In addition, mean tear production was not decreased significantly when comparing each clinical group with the control subjects (17.8 +/- 4.4). However, the relative frequency of eyes with significantly decreased tear production (< 9 mm) was 23.6% in all 144 eyes. In addition, the relative frequency of significantly decreased tear production did not differ (P = 0.52) between eyes of patients with asymptomatic HIV infection (35.7%), LAS or ARC (21.4%), and AIDS (24.1%). In addition, the relative frequency of significantly decreased tear production did not differ (P = 0.30) between eyes of patients with a CD4+ count of more than 400 cells/microliters (23.1%; n = 26), 400 to 200 cells/microliters (31.3%; n = 48), 200 to 50 cells/microliters (14.3%; n = 42), and less than 50 cells/microliters (21.4%; n = 28).
  
  
  CONCLUSIONS
  The authors data show that decreased tear production occurs in approximately 20% to 25% of patients with HIV infection. This increased frequency of decreased tear production is not associated with the CD4+ count, or related to the severity of HIV disease, respectively. The possibility of an autoimmune-like pathogenesis of abnormalities of tear production in patients with HIV infection should be studied intensively.
authors.affiliation: Augenklinik im Universitätsklinikum Rudolf Virchow, Alexander von Humboldt Universität zu Berlin, Germany.
authors.forename: S A
authors.initials: SA
authors.lastname: Geier
authors.forename: S
authors.initials: S
authors.lastname: Libera
authors.forename: V
authors.initials: V
authors.lastname: Klauss
authors.forename: F D
authors.initials: FD
authors.lastname: Goebel
mesh_terms: D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D015483:HIV Antibodies / Q000032:analysis; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D015497:HIV-1 / Q000276:immunology; D015498:HIV-2 / Q000276:immunology; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D007765:Lacrimal Apparatus / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012859:Sjogren's Syndrome / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D013666:Tears / Q000378:metabolism
chemical_list: D015483:HIV Antibodies