title: 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.affiliation: Department of Surgery, Radiology Anaesthesia and Intensive Care, the University of the West Indies and University Hospital of the West Indies, Kingston 7, Jamaica. Lizettemowatt@yahoo.com.
authors.forename: L
authors.initials: L
authors.lastname: Mowatt
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000209:etiology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000209:etiology; D003230:Conjunctival Neoplasms / Q000209:etiology; D017726:Cytomegalovirus Retinitis / Q000209:etiology / Q000517:prevention & control; D005128:Eye Diseases / Q000209:etiology*; D005134:Eye Neoplasms / Q000209:etiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D009901:Optic Nerve Diseases / Q000209:etiology; D012164:Retinal Diseases / Q000209:etiology; D012514:Sarcoma, Kaposi / Q000209:etiology; D014652:Vascular Diseases / Q000209:etiology
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents