Abstract
BackgroundOcular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern. Although they have been described in the Western population, there are not many such studies in the HAART era from India. This study aims to present the clinical profile, systemic correlation, and visual outcome in HIV-positive patients in relation to HAART in comparison with pre-HAART Indian studies and current Western data. Ocular findings and systemic correlation in 1,000 consecutive patients with HIV seen at a tertiary eye care center were analyzed. This study uses a prospective observational case series design.ResultsAge range of the patients was 1.5 to 75 years. Ocular lesions were seen in 68.5% of the patients (cytomegalovirus (CMV) retinitis was the commonest). The commonest systemic disease was pulmonary TB. Mean interval between HIV diagnosis and onset of ocular lesions was 2.43 years. CD4 counts range from 2 to 1,110 cells/mm3. Immune recovery uveitis (IRU) was seen in 17.4%. Interval between HAART initiation and IRU was 4 months to 2.5 years. Recurrence of ocular infection was seen in 2.53% (post-HAART) and > 20% (pre-HAART). Overall visual outcome showed improvement in about 14.3% and was maintained in 71.6% of the patients.ConclusionsCMV retinitis is the commonest ocular opportunistic infection in India, even in the HAART era. Newer manifestations of known diseases and newer ocular lesions are being seen. In contrast to Western studies, in our patients on HAART, ocular lesions do not always behave as in immunocompetent individuals. Ocular TB needs to be kept in mind in India, as well as other neuro-ophthalmic manifestations related to cryptococci, especially in gravely ill patients. Occurrence and frequency of various ocular opportunistic infections in developing nations such as India have significant variations from those reported in Western literature and need to be managed accordingly.
Highlights
Ocular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern
HAART reduced the risk of OIs, newer manifestations of known diseases such as in CMV and neovascularization or retinal detachment and newer ocular lesions such as drug-related reactions are being seen in patients on HAART
Ocular opportunistic infections may present with significant inflammatory reaction in patients on HAART
Summary
Ocular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern. They have been described in the Western population, there are not many such studies in the HAART era from India. Ocular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern and have been described in the Western population. There are not many long-term studies on ocular lesions of HIV-positive patients in relation to HAART, Results One thousand HIV-positive patients were included in the study Their age ranged between 18 months to 75 years (median age, 35 years). Interval between diagnosis of HIV and onset of ocular lesions ranged from 10 days to Ocular lesions due to HIV
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