Retinal manifestations of HIV-1 and HIV-2 infections among hospital patients in The Gambia, west Africa.
BACKGROUND
In developed countries, 50-75% of AIDS patients develop retinal complications and about 20-40% acquire cytomegalavirus (CMV) retinitis. We conducted a cross-sectional survey to determine prevalence of these in The Gambia where both HIV-1 and HIV-2 infection are present and the prevalence of HIV-1 is rising.


METHODS
All patients attending hospital whose percentage CD4+ cells (CD4%) was below 14, the level associated typically with an AIDS diagnosis, and one half of those whose CD4% was 14 or above were asked to join the study. Fifty-six HIV-1, 52 HIV-2 and 12 dually infected patients were recruited. Photographs of the fundi were taken and interpreted independently. The findings were related to the patients' percentage CD4+ cells.


RESULTS
The CD4% was < 14 in 40 patients and < 7 in 17 patients. Thirty-six patients were male. No cases of CMV retinitis were found. Four patients whose CD4% were 4, 5, 11 and 23 had cotton wool spots ranging in number from 1 to 14 for any one patient. The prevalence of cotton wool spots was 8% (95% CI, 0-16%) among patients with CD4% below 14 and 12% (95% CI, 0-27) among patients with CD4% below 7. One of the 4 patients had associated microaneurysm and blot haemorrhages typical of more advanced HIV microvasculopathy.


CONCLUSIONS
CMV retinitis is less common in The Gambia than in developed countries. Non-infectious retinopathy may also be less common.
Jaffar
S
S
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK. S.Jaffar@lshtm.ac.uk
Ariyoshi
K
K
Frith
P
P
Okouchi
Y
Y
Sabally
S
S
Ajewole
T
T
Bailey
R
R
Lee
P S
PS
Corrah
T
T
Johnson
G
G
Faal
H
H
Whittle
H
H
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D017726:Cytomegalovirus Retinitis / Q000453:epidemiology*; D005260:Female; D005714:Gambia / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000150:complications* / Q000453:epidemiology