Abstract
Human immunodeficiency virus (HIV) causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy) has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%), followed by posterior blepharitis (Meibomian gland dysfunction) seen in 23 patients (6.3%) and anterior blepharitis seen in 12 patients (3.3%). Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top three most common anterior segment disorders in the HAART era. The statistical analysis showed no association between age, sex, CD4 count, duration of infection or receiving HAART and anterior segment disorders. Anterior segment abnormalities reduce the quality of life of patients, so ophthalmologists have to be aware and complete ocular examination should be performed in all HIV infected patients.
Highlights
Nowadays, Human Immunodeficiency Virus (HIV) is still a major public health problem in Thailand
Anterior segment disorders and HIV infections in HAART era of life of patients, so ophthalmologists have to be aware and complete ocular examination should be performed in all HIV infected patients
The surveillance for HIV infection from the division of epidemiology, The Ministry of Public Health of Thailand from September 1984 to March 2011 revealed that the number of HIV infected patients in Thailand was 371,844 in which 114,043 patients were in the northern part of Thailand. [2,3]
Summary
Human Immunodeficiency Virus (HIV) is still a major public health problem in Thailand. Poorer availability of HAART in most developing countries is reflected by a higher level of profound immune suppression, with increased susceptibility to opportunistic infections.[5] During the HAART era, there has been an estimated 80% decrease in the incidence of CMV retinitis.[6] With HAART, there is a reduction in the number of opportunistic infections, improvement in the length and quality of life; patients are less likely to be blind from posterior segment infections.[7] This longer survival rate may lead to an increased prevalence of the anterior segment and external ocular disorders. This study has been undertaken to identify the prevalence of the anterior segment and external ocular disorders in HIV infected patients in Chiang Mai University Hospital and to find the associated factors of the abnormal manifestations
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