Vol.14
No. 1, Januray, 2004
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.
