202 Retinopathy and enteropathy in HIV patients, a hypothetical concept beyond Virus and CD4 levels- a study from Varanasi, North India

Abstract

Background: Based on our previous observations which were published (Asian journal of ophthalmology, 2006. July p341-48 and BMC Infectious Diseases 2006, 6:39) we thought of re evaluating the results of the hospital based cohort to propose possible hypothesis and evaluate it in prospective manner. Aim: To evaluate the effect of local immunity on development of HIV retinopathy and enteropathy in a hospital based cohort at Institute of Medical Sciences, Banaras Hindu university, Varanasi, India. Methods: All the patients with HIV retinopathy or enteropathy (diagnosis of which was established by ruling out all other pathologies like opportunistic infections, malignancies in cases of enteropathy and infections, malignancies and other confounders like hypertension, diabetes in retinopathy cases) were enrolled and equal number of controls, who had similar symptoms during the same time was recruited for comparison. The baseline characters, CD4 levels, duration of symptoms, number of episodes and other possible confounders were compared in the groups. Results: The multivariate analysis for the retinopathy suggested that the local inflammation & immunity are most important risk factors as significant number of patients have near normal circulating CD4 counts. All retinopathy patients had some form of local infection (which indirectly indicated a decreased local immunity) which further supports our hypothesis. Similarly in patients with enteropathy, we found that around 78% of chronic and 45% of acute diarrheal episodes were experienced by patients with CD4 counts of >200 cells/μL, indicating a regional immunosuppression. Similar observations were made earlier (GUT. 1995;37:524-29) where authors observed that, loss of CD4 cells in intestinal mucosa of the patients with diarrhea, were more pronounced than peripheral CD4 levels and their relation is quite variable. Conclusions: The local immunity, an important factor to prevent retinopathy as well as enteropathy may therefore be variable and therefore they can be observed even in patients with good immunity (i.e. peripheral CD4 > 200). However, it would be premature to draw definitive conclusions beyond this, as the present study is retrospective one and number of patients analyzed was relatively small.