Ophthalmic manifestations of HIV infections in India in the era of HAART: analysis of 100 consecutive patients evaluated at a tertiary eye care center in India.
OBJECTIVE
To evaluate ophthalmic manifestations in patients with Human Immunodeficiency Virus (HIV) infection in the era of highly active antiretroviral therapy (HAART) at the apex institute for eye healthcare in India.


METHODS
This prospective study was undertaken between October 2004 and December 2005. A complete ophthalmological and systemic examination was performed on each patient. Relevant investigations were carried out in selected patients.


RESULTS
One hundred consecutive HIV infected patients (199 eyes) were examined for ophthalmic manifestations. Of these 17% (17/100) had Category A HIV infection (asymptomatic or acute HIV or persistent generalized lymphadenopathy), 23%(23/100) had Category B HIV infection (symptomatic, not A or C), 60%(60/100) had Category C HIV infection (AIDS indicator condition).76%(70/100) were male and 24%(24/100) were female. The median age of patients was 34 years and 52%(52/100) were in the fourth decade. 68%(68/100) patients were on HAART. 45% (45/100) patients had ophthalmic manifestations, the most common being cytomegalovirus (CMV) retinitis (20%) (20/100). Retinal detachment was seen in 70% (14/20) of CMV retinitis patients. HIV vasculopathy was seen in 11% (11/100) of patients. Other lesions included immune recovery uveitis (IRU) (5%)(5/100), acute retinal necrosis (ARN) (3%)(3/100), choroiditis (2%)(2/100), neuro-ophthalmic manifestations (12%)(12/100), complicated cataract (6%)(6/100), keratouveitis (1%)(1/100) and corneal ulcer (1%)(1/100). 7%(7/100) patients presented to us with ophthalmic manifestation as the only presenting sign of HIV infection. Amongst those who had ophthalmic involvement, about 50% (19/40) patients had CD4 count below 100 cells/micro liter and 70% (28/40) patients had CD4 count below 200 cells/micro liter.


CONCLUSIONS
CMV Retinitis (20%) (20/100) is still the most common manifestation of HIV infection in this series, even in the era of HAART, and is more common than HIV vasculopathy. Immune recovery uveitis is appears to be more common with the introduction of HAART in absence of affordable anti CMV therapy in India. 7% (7/100) of patients present with ophthalmological features as the initial manifestation of HIV. As before, most (70%) (28/40) of the ophthalmic manifestations of HIV infection are present when CD4 count is less than 200 cells/micro liter.
Gharai
Sujit
S
Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. sujitgharai@gmail.com
Venkatesh
Pradeep
P
Garg
Satpal
S
Sharma
S K
SK
Vohra
Rajpal
R
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015828:Eye Infections, Viral / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014792:Visual Acuity / Q000502:physiology