AIDS and EYE

Gilbert WS Simanjuntak
Dept. of Ophthalmology School of Medicine Christian University of Indonesia Jakarta, Indonesia

no financial interest in items discussed

HIV itself has been isolated from tears, conjunctiva, cornea, aqueous humor, iris, sclera, vitreous humor, and retina

OCULAR MANIFESTATIONS OF HIV INFECTION

Trans Am Ophthalmol Soc. 1995

1163 patients were seen for ophthalmologic evaluation.

781 had the acquired immune deficiency syndrome (AIDS) 226 had symptomatic HIV infection (AIDs-related complex [ARC 156 had asymptomatic HIV infection.

Non-infectious HIV retinopathy was the most common ocular complication

50% of the patients with AIDS 34% ofthe patients with ARC 3% of the patients with asymptomatic HIV

Cytomegalovirus (CMV) retinitis was the most common opportunistic ocular infection
37% of the patients with AIDS. The median time to a visual acuity of 20/200 or worse for all eyes with CMV retinitis :13.4 months

Other opportunistic ocular infections

Ocular toxoplasmosis, varicella zoster virus retinitis, and Pneumocystis choroidopathy each occurring in < 1% of the patients with AIDS.
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The most common cause of a neuro-ophthalmic lesion was cryptococcal meningitis, and 25% of the patients with cryptococcal meningitis developed a neuro-ophthalmic complication. Cytomegalovirus retinitis occurs almost exclusively in patients whose CD4+ counts are <50 cells/l
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Infectious uveitis in immunocompromised patients is a rapidly progressive and blinding disorder that can be halted by prompt administration of specific antimicrobial therapy

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The long-term antimicrobial treatment is essential for the prevention of further attacks or activity in the not yet affected eye. Therefore a rapid identification of the causative agent is indispensable

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the ophthalmo clinical features are not discriminatory for a specific diagnosis the correct diagnosis of the intraocular infection cannot be based on systemic findings only, because the patients might suffer from multiple infections Consequently, the analysis of intraocular fluids constitutes an important tool for a correct and quick diagnosis

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Infectious Uveitis in Immunocompromised Patients

Aqueous Analysis (Am J Ophthalmol 2007)

Of 56 immunocompromised patients 43 (77%), all posterior and panuveitis, had intraocular infections. Twenty-one (49%) had CMV, three (7%) had VZV, 11 (26%) had T. gondii, six (14%) had Treponema pallidum, and one (2%) each had Aspergillus and Candida. In AIDS patients, CMV was the most common cause. A strong correlation between AIDS and ocular syphilis was also observed (P .007). In non-AIDS immunocompromised patients, T. gondii was most frequently detected.
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Uveal Tract
Anatomically composed of:
The iris The ciliary body The choroid

Middle vascular layer of the eye Contributes blood supply to the outer retina

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HIV and Kaposi Sarcoma

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Syphilis

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CMV Retinitis

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Treatment
The introduction of potent antiretroviral therapies, HAART, involves a combination of drugs During the first few months of therapy, most patients on HAART experience a rise in CD4+ Tlymphocyte numbers
This response can occur even in patients with advanced disease. With HAART, there is a reduction in the number of opportunistic infections HIV resistance to the drugs can develop with prolonged use.
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Failure of HAART may eventually result in the reemergence of oncecommon opportunistic infections in individuals with HIV disease

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Opportunistic infection, treatment

Tailored, based on causative agent
Toxoplasma : anti-Toxo VZV : started in 72 hours, anti virus HSV Keratitis : oral antiviral, epithelial debridement with topical antiviral Bacterial : as per culture/sensitivity test CMV Retinitis : intravitreal antiviral

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Pneumocystic choroiditis

Cryptococcus involvement of optic nerve and retina

Multiple choroidal tubercles due to ocular tuberculosis

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Intravitreal injection

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