Ophthalmic manifestations and risk factors for mortality of HIV patients in the post-highly active anti-retroviral therapy era.
BACKGROUND
To evaluate the ophthalmic manifestations and risk factors for mortality in HIV patients in the post-highly active anti-retrovirus therapy (HAART) era.


METHODS
Retrospective study.


METHODS
151 patients with HIV infection.


METHODS
Review of all HIV patients who have attended the Hong Kong Eye Hospital between 2000 and 2007.


METHODS
Ocular findings especially opportunistic infections and medical information including mortality during follow up.


RESULTS
At presentation, 139 (92.1%) patients were already diagnosed with HIV and 58 (41.7%) had an AIDS indicator condition. Fifty-one (33.8%) patients had HIV-related eye disease on presentation and the leading manifestations were cytomegalovirus (CMV) retinitis and HIV microangiopathy. Low baseline CD4 cell count <100 cells/L was significantly related with HIV-related ophthalmic manifestations and CMV retinitis at presentation (P < 0.013). 105 patients were followed for 6 months or more and the mean follow-up was 4.8 years. There was no significant change in visual acuity compared with baseline (P = 0.13). 20 (19.0%) patients had one eye with final visual acuity of 20/200 or worse and the leading cause for poor vision was CMV retinitis. 11 (10.5%) patients died during the follow-up due to complications of HIV/AIDS. The presence of HIV retinal microangiopathy was significantly associated with mortality (P = 0.005).


CONCLUSIONS
CMV retinitis remains the main HIV-related ocular disease in the post-HAART era. HIV retinal microangiopathy might be an important prognostic factor for mortality. Appropriate ophthalmic monitoring is justified to detect for ophthalmic complications in HIV patients regardless of HAART use in order for prompt initiation of treatment.
Lai
Timothy Y Y
TY
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China. tyylai@cuhk.edu.hk
Wong
Raymond L M
RL
Luk
Fiona O J
FO
Chow
Vanissa W S
VW
Chan
Carmen K M
CK
Lam
Dennis S C
DS
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000401:mortality / Q000821:virology; D015828:Eye Infections, Viral / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014652:Vascular Diseases / Q000401:mortality / Q000821:virology; D014792:Visual Acuity / Q000502:physiology
D017320:HIV Protease Inhibitors