Ocular Manifestations of HIV: Our
Experience
Subina Narang, Sonika, Chintan
Malhotra, Reema Sood, Sudesh K Arya,
Sunandan Sood
INTRODUCTION
The incidence of AIDS is increasing.
Over 32.6 million people are
affected with AIDS worldwide. In
India, experts predicated 3.26
million people to be infected with
HIV by the year 2000. Ocular
involvement is known to occur in
40-70% of AIDS patients1.
Ocular manifestations include non
infectious microangiopathy,
opportunistic infections, neuro-ophthalmic
lesions and unusual neoplasms like
Kaposi's sarcoma. The literature on
HIV from India is scanty. The
present study was done to find the
spectra of ocular disease in HIV in
our Hospital.
METHODS
It is a retrospective study of
ocular findings in 20 AIDS patients
admitted in our institute between
2001 and 2003. As a routine all the
in-patients with AIDS were subjected
to funds examination.
RESULTS
Age of the patients ranged from 7 to
45 years. (mean 26 year). There
were 17 male and 3 female patients.
Out of the 20 patients, 16(80%)
presented with systemic complaints
while 4(20%) had ocular features as
the presenting symptom & were later
referred to Medicine Department. Out
of the 16 patients with systemic
complaints, 3 (18.7%) had ocular
involvement -2 had cotton wool spots
with microaneurysms (HIV
Retinopathy) and I had retinal
granuloma with superficial
haemorrhages. Of the 4 patients
with ocular complaints, one
presented with sudden painless loss
of vision and had CMV retinitis and
optic neuropathy (Fig.1 a & b), 2
with gradual diminuition of vision
had CMV retinitis (Fig. 1 c & d ),
and one had painful vesicular herpes
zoster eyelid eruptions.
Fig.1: a
and b. Fundus photographs showing
multiple cotton wool spots, retinal
haemorrhages and marked disc oedema
due to CMV retinitis. c. & d. Funds
photographs showing multiple areas
of retinal haemorrhages (inset c)
and cotton wool spots due to CMV
retinitis.
DISCUSSION & CONCLUSION
Our Study showed ocular involvement
in 35% of the cases. Out of which
CMV retinitis was the commonest
lesion (20%). Results of our study
matched with the study of 100
patients conducted by Biswas et al
where ocular involvement was seen in
40% of the patients and CMV
retinitis was the commonest HIV
related ophthalmic lesion (17%).
Probably most of the patients
present late in the course of the
disease when CD4 counts are 100
cells/mm3 accounting for the high
incidence of CMV retinitis in our
set-up. However, the facility for
evaluation of CD4 count does not
exist in our institution. Lack of
awareness and social stigma
associated with the disease could be
the reason for the delayed
presentation. The unusual feature
in our study was the initial
presentation of AIDS with ocular
complaints in 4 cases.
REFERENCES
-
Cunninghom ET, Margotis TP.
Ocular manifestations of HIV
infection. N Eng J Med 1998;
339:236-44.
-
Biswas J, Madhavan HN, George
AE, Kumaraswamy N, Solomon S.
Ocular lesions associated with
HIV infection in India: A series
of 100 consecutive patients
evaluated at a referral center.
Am J Ophthalmol 2000; 129:9-15.
Address for Correspondence
Dr. Subina Narang, Deptt. of
Ophthalmology,
Govt. Medical College & Hospital,
Chandigarh.
