Human Immunodeficiency Virus Retinopathy Research Articles

Ocular manifestations in HIV patients attending a tertiary care hospital in Eastern India and correlation of posterior segment lesions with CD4+ counts.

We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts. This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case. A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30-39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001). Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections.

The ocular manifestations of human immunodeficiency virus and syphilis coinfection

Objective: To investigate the ocular manifestations of human immunodeficiency virus (HIV) and syphilis coinfection. Methods: A retrospective analysis of the ocular manifestations was carried out in 27 patients (54 eyes) diagnosed as syphilis and HIV coinfection by the Department of Infectious Medicine in Peking Union Medical College Hospital during the years of 2006-2017. The research included 26 males and 1 female, aging from 24 to 76 years old, with a mean age of 40.40±12.94 years old. Ocular anterior segments were examined with slit-lamp microscope. Fundus examinations were conducted with papillary dilation, fundus photography. Results: At the first visit, there were 2 eyes without light perception, 4 eyes with light perception, 1 eye with hand movement, 1 eye with finger counting, 2 eyes with 0.01-0.09 eyesight, 8 eyes with 0.1-0.2 eyesight, 12 eyes with 0.25-0.4 eyesight, 15 eyes with 0.5-0.9 eyesight, 9 eyes with 1.0-1.5 eyesight. Among the 27 patients (54 eyes) coinfected with HIV and syphilis, keratic precipitates were identified in 20 eyes, aqueous flare positive in 20 eyes, float positive in 15 eyes, and iris posterior synechias in 7 eyes. Nineteen eyes were diagnosed as syphilis uveitis, including 2 eyes with syphilis anterior uveitis and 17 eyes with syphilis panuveitis, among which, vitreous inflammatory opacity was observed in all 19 eyes, disk atrophy in 2 eyes, optic edema in 1 eye, vitreous hemorrhage in 1 eye, retinal detachment in 2 eyes, retinal hemorrhage and white vein in 1 eye. In addition, 8 eyes were diagnosed as HIV retinopathy, all manifested as cotton-wool spot. Among the 8 eyes, 4 were diagnosed as cytomegalovirus retinitis, 3 showed retinal yellow-white lesions, and 1 was in late phase which showed retinal pigmentation. The incidence of both HIV and syphilis coinfection patients and male homosexuality population increased. The most common ocular manifestation of HIV and syphilis coinfection was syphilis panuveitis. Six patients first visited the Department of Ophthalmology, and were then diagnosed as HIV and syphilis coinfection. Conclusions: The ocular manifestations of HIV and syphilis coinfection are diversified, which can be manifested as fundus necrotic lesions as well as anterior and posterior inflammatory. For HIV positive patients, syphilis serologic test should be routinely performed. The same, syphilis positive patients should be tested for HIV serum antibodies, in order to improve the diagnosis level of HIV/syphilis coinfection and give timely etiological treatment, which is of vital importance for saving visual acuity. (Chin J Ophthalmol, 2019, 55:267-272).

Ocular Manifestations in Patients with HIV infection.

To evaluate the characteristics and incidence of ophthalmic manifestations in patients with HIV (Human Immunodeficiency Virus) infection. Aretrospective evaluation of medical records of 147 patients with HIV infection (22 female, 125 male), the average age of 41 (range 22-79 years) examined by an ophthalmologist at the Clinic of Ophthalmology at the University Hospital Ostrava in years 1987 - 2015. Ophthalmic manifestations of HIV were observed in 16 patients (11.9 %). There was not observed ocular involvement in patients in asymptomatic stage of HIV infection. Ophthalmic complications were observed in 1 patients (0.7 %) in early symptomatic stage and 15 patients (10.2 %) with stage AIDS (Acquired Immune Deficiency Syndrome). The most frequent ocular symptoms were caused by the virus (HIV retinopathy, mikroangiopathy) - total of 13 infected (76.5 %). Three patients had opportunity infections (17.6 %). As aresult of the underlying AIDS disease 5 patients died. Ocular findings were observed at 2 of those (40.0 %). Ocular manifestation are common finding in late stages of HIV infection. Ophthalmic examination is an integral part of the diagnostic algorithm of patients with HIV infection. Most frequently, ocular symptoms have been found within the group of patients with advanced part of disease, which is in relation with the body´simmune defense decrease thus death itself.

HIV-infected individuals on long-term antiretroviral therapy are at higher risk for ocular disease.

Introduction of antiretroviral therapy (ART) has dramatically reduced the incidence of infectious ocular diseases in human immunodeficiency virus (HIV)-infected individuals. However, the effects of long-term ART and chronic HIV infection on the eye are ill-defined. This study determined the occurrence and severity of ocular diseases among 342 participants in a rural South African setting: HIV-naïve (n = 105), HIV-infected ART-naïve (n = 16), HIV-infected on ART for 36 months (long-term ART; n = 165). More HIV-infected participants presented with an external eye condition, in particular blepharitis, than HIV-naïve individuals (18% vs. 7%; age-adjusted odds ratio (aOR) = 2·8, P < 0·05). Anterior segment conditions (particularly keratoconjunctivitis sicca and pterygium) were also more common (50% vs. 27%; aOR = 2·4; P < 0·01). Compared with individuals on short-term ART, participants receiving long-term ART were more likely to have clinically detectable cataract (57% vs. 38%; aOR = 2·2, P = 0·01) and posterior segment diseases, especially HIV retinopathy (30% vs. 11%; aOR = 3·4, P < 0·05). Finally, long-term ART was significantly associated with presence of HIV retinopathy (P < 0·01). These data implicate that ocular disease is more common and of more diverse etiology among HIV-infected individuals, especially those on long-term ART and suggest that regular ophthalmological monitoring of HIV-infected individuals on ART is warranted.

Analysis of Retinochoroidal Vasculature in Human Immunodeficiency Virus Infection Using Spectral-Domain OCT Angiography

To describe the retinochoroidal vascular alterations in patients with human immunodeficiency virus (HIV) infection using en face OCT angiography (OCTA). Cross-sectional study. Twenty-six patients with HIV infection (5 women, with and without HIV retinopathy) were included in the study. Nineteen healthy participants (7 women) with no known ocular disease were recruited as healthy controls. Multimodal imaging was performed using OCTA (Optovue RTVue XR Avanti; Optovue, Inc, Fremont, CA), enhanced-depth imaging OCT (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), color fundus photography, and fluorescein angiography (FA). Vessel flow density (VFD) was calculated automatically by the OCTA software. Morphologic changes in the retinochoroidal vasculature in the posterior pole on OCTA were assessed by 2 trained independent graders and were compared with the findings on clinical examination and other imaging techniques. Prevalence of microvascular alterations on OCTA among patients with HIV and differences in the VFD in different macular sectors compared with healthy controls. Among all eyes with clinically detectable HIV retinopathy, there was evidence of retinal vascular telangiectasia, capillary loops, and increased intercapillary spacing. The mean VFD values were lower among patients with HIV retinopathy compared with those with HIV and no retinopathy and healthy controls (both P < 0.05). Foveal avascular zone area was abnormally enlarged among patients with HIV compared with healthy controls (P= 0.05). Five eyes (23.53%) without clinical or angiographic evidence of retinopathy demonstrated retinal vascular telangiectasia and increased intercapillary spacing on OCTA. The inner choroidal vasculature appeared to be mostly unaffected in HIV. OCT angiography provides noninvasive high-resolution imaging of the retinochoroidal vascular network in patients with HIV. Compared with conventional imaging, OCTA can demonstrate precise microvascular structural alterations in the retinal vessels and seems to be a sensitive tool in detecting HIV retinopathy.

Ocular complications in HIV positive patients on antiretroviral therapy in Ghana.

BackgroundPatients infected with human immunodeficiency virus (HIV) usually develop some form of ocular complication in the different segments of the eye due to immune deficiency. In Ghana, data regarding ocular complications among HIV/AIDS patients is scarce. This study investigated the occurrence of ocular complications in HIV infected patients undergoing antiretroviral therapy at the Agogo Presbyterian Hospital in the Ashanti Region of Ghana.MethodsBlood samples were taken from 100 confirmed HIV infected patients. The CD4 + T cell count and WHO clinical staging were determined. The patients were taken through thorough ophthalmic assessments to determine any ocular complications.ResultsForty-eight patients (48 %) had at least one HIV-related ocular complication. These complications occurred more frequently among those with CD4 counts below 200 cells/μL. Of the participants with HIV-related ocular complications, 11 (23 %) had retinal microvasculopathy, 10 (21 %) showed allergic conjunctivitis, 7 (15 %) had HIV retinopathy and 7 (15 %) had conjunctival carcinoma. All the participants in the study were on first-line antiretroviral therapy; 68 % were females and 72 % were in the Stage 3 of the WHO Clinical Staging of HIV infection.ConclusionThe prevalence of ocular complications in HIV positive persons under treatment in Ghana is high. Lower CD4 + T cell counts coupled with age were predisposing factors to HIV-related ocular complications.

Bilateral ischemic maculopathy in acquired immune deficiency syndrome

BackgroundThis brief report aims to report a case of bilateral macular ischemia as a cause of sudden decreased vision in a patient with acquired immune deficiency syndrome (AIDS).FindingsA 26-year-old male with disseminated cryptococcal meningitis, Candida thrush, Pneumocystis jiroveci pneumonia, and positive human immunodeficiency virus (HIV) infection with CD4 count of 4 cells/μl complained of sudden blurred vision in both eyes while on treatment with systemic antiviral, antifungal, and antibiotic medications. Ocular examination revealed HIV retinopathy changes with significant macular ischemia in both eyes, which was confirmed by fluorescein angiography. One dose of intravitreal foscarnet (1.2 mg/0.1 cc) was injected in both eyes. Laboratory work-up of serum and vitreous samples showed negative cytomegalovirus (CMV) titers. At 2 weeks of follow-up, he was started on treatment with atripla, a combination anti-retroviral therapy for AIDS. At 6 weeks of follow-up, there was an improvement in visual acuity and clinical findings.ConclusionsNoninfectious HIV retinopathy in AIDS is common, but bilateral macular ischemia is a rare presentation. It is important to rule out CMV retinitis as it is a major cause of visual morbidity among AIDS patients.

Fundus characteristics of acquired immune deficiency syndrome in human immunodeficiency virus retinopathy

Objective To observe the fundus characteristics of acquired immune deficiency syndrome (AIDS) with human immunodeficiency virus (HIV) retinopathy.Methods Eighty eyes of 52 AIDS patients with HIV retinopathy were enrolled in this study.The patients included 42 males (67 eyes) and 10 females (13 eyes).The patients ages ranged from 16 to 78 years,with a mean age of (43±12) years.All patients' visual acuity,intraocular pressure,slit-lamp microscopy and mydriatic indirect ophthalmoscopy,fundus color photography and CD4+ T cell count was documented.Experienced ocular fundus doctors carried out fundus examinations.Retinopathy characteristics were recorded.Seventeen patients (24 eyes) were followed for a period between two days to two years,with a median of 125 days.We failed to follow up the remaining 35 patients (56 eyes) due to death or moving away.Results Among 52 patients (80 eyes),28 patients (56 eyes,70.0％) had bilateral HIV retinopathy and 24 patients (24 eyes, 30.0％) had unilateral HIV retinopathy.Cotton-wool spots (CWS),mostly located close to temporal peripapillary vessels,were found in 46 patients (72 eyes,90.0％).Six patients (eight eyes,10.0％) were found to have flaming or spotting hemorrhage located in posterior pole.Among 72 eyes with CWS,57 eyes were found to have CWS only and 15 eyes were found to also have retinal hemorrhage,mostly located near CWS.Among 24 eyes of 17 followed-up patients,three eyes of three patients were found with no significant changes during the less than two week follow-up.In 18 eyes of 11 patients,CWS or hemorrhage disappeared after one to three months without treatment and in five eyes new CWS or hemorrhage were found in other parts of the posterior pole.Three eyes of three patients initially considered as lint plaque-like lesions were eventually detected with CMVR as lesions during one to five months follow-up.Conclusion CWS are the most common ocular lesions in HIV retinopathy. Key words: Acquired immunodeficiency syndrome/complications; HIV infections/complications; Retinal degeneration/diagnosis; Disease attributes

Ocular manifestations in 321 male consecutive cases of human immunodeficiency virus infection/acquired immunodeficiency syndrome at an HIV-referral centre

BackgroundMost studies on the ocular manifestations of human immunodeficiency virus (HIV) infection are on cases of acquired immunodeficiency syndrome (AIDS), not including asymptomatic carriers of HIV. With this background, we proceeded to study all the HIV-infected individuals attending our centre, with the aim:a. To study the ocular manifestations of HIV.b. To correlate those manifestations with the CD4+ T-lymphocyte counts.c. To compare our findings with other studies. MethodA cross-sectional study involving a detailed ocular examination of 321 cases of HIV/AIDS was done. Automated perimetry, digital fundus photography and fundus fluorescein angiography were done for relevant cases. The last 125 cases were subjected to Schirmer's test and tear film break-up time. ResultsWe studied 321 male HIV cases (642 eyes), with a mean age of 36.78 years, mean CD4+ count of 276.54 cells/μL, 78.82% of them being on anti-retroviral therapy. Ocular manifestations were seen in 87 out of 321 cases, 72.41% of them being asymptomatic carriers of HIV. The ocular findings seen were conjunctival microvasculopathy, molluscum contagio-sum, dry eye, neuro-ophthalmic manifestations, anterior uveitis, posterior uveitis, and HIV retinopathy, only the last three of which had a significant association with CD4+ counts. The overall prevalence of ocular lesions also had a significant association with CD4+ counts. ConclusionOcular manifestations are common in asymptomatic carriers of HIV. Anterior uveitis, posterior uveitis and HIV retinopathy have a significant association with CD4+ counts and are reliable indicators of low CD4+ count.

Ocular findings in human immunodeficiency virus patients in Washington, DC

The purpose of the study was to determine the prevalence of ocular diseases in human immunodeficiency virus (HIV) patients in Washington, DC in the era of highly active antiretroviral therapy (HAART). This was a cross-sectional study of patients with HIV who were seen by the ophthalmology consultation service between September 2003 and May 2011 at a single academic institution in Washington, DC. Medical history and ophthalmic findings were reviewed. Patients with complete laboratory data dated within 3 months of their presenting eye examination were included. Descriptive statistics were performed. The records of 151 patients were included in the final analysis. All patients had complete laboratory data dated within 3 months of their presenting eye examination. Sixty-eight (45 %) patients and fifty-eight (50 %) of those with a diagnosis of acquired immune deficiency syndrome (AIDS) were diagnosed with an HIV-related ophthalmic disease. The leading anterior segment disease was herpes zoster ophthalmicus and the leading posterior segment disease was HIV retinopathy. Of the 151 included patients, 78 (52 %) were receiving HAART at the time of the examination. Thirty-one (42 %) of those not receiving HAART were diagnosed with an HIV-related ophthalmic disease. In this study, we find that the overall prevalence of ocular disease has decreased since the introduction of HAART. However, HIV patients continue to be predisposed to developing ophthalmic disease at higher rates than the general population. Visual dysfunction remains an important source of morbidity in HIV patients, particularly in those with AIDS. Measures for improvement include increased communication between infectious disease specialists and ophthalmologists to ensure adherence to HAART and routine eye examinations.

RETINAL PIGMENT EPITHELIOPATHY, MACULAR TELANGIECTASIS, AND INTRARETINAL CRYSTAL DEPOSITS IN HIV-POSITIVE PATIENTS RECEIVING RITONAVIR

The purpose of this study was to describe the occurrence of a retinal pigment epitheliopathy associated with macular telangiectasis and intraretinal crystal deposits in three human immunodeficiency virus-positive patients receiving long-term ritonavir as part of highly active antiretroviral therapy. The patient's records were reviewed. The CD4 T-cell counts at presentation were 163 cells per microliter, 464 cells per microliter, and 349 cells per microliter, and viral loads were undetectable in all patients. None of the patients had a concurrent AIDS-defining illness. Other significant medical history included hyperlipidemia in one patient and a remote history of lymphoma and tuberculosis in a second patient. Initial visual acuity ranged from 20/32 to 20/400, with a median of 20/150. Anterior segment examination and intraocular pressures were normal in all eyes. Posterior segment examination revealed bilateral macular retinal pigment epitheliopathy with intraretinal crystalline deposits. No hemorrhage or cotton wool spots were seen consistent with human immunodeficiency virus retinopathy, and there was no evidence of previous or active cystomegalovirus retinitis. Fluorescein angiography revealed parafoveal telangiectasis with late leakage in two of the three patients. Optical coherence tomography showed thickening of the macula in three eyes and inner foveal cysts in two eyes. Autofluorescence performed on one patient revealed complete loss of normal retinal pigment epithelium autofluorescence corresponding to the area of retinal pigment epitheliopathy bilaterally. The only medicine common to all 3 patients was ritonavir, and the duration of ritonavir therapy before presentation was 19 months in one patient, 30 months in the second patient, and 5 years in the third patient. Retinal changes characterized by retinal pigment epitheliopathy, parafoveal telangiectasias, and intraretinal crystal deposits occurred in three human immunodeficiency virus-positive patients on long-term ritonavir as part of highly active antiretroviral therapy.

A presentation of aids-related ophthalmic disease in a severely immunocompromised patient

Background: Human immunodeficiency virus (HIV) retinopathy is the most common ocular manifestation of the acquired immunodeficiency syndrome (AIDS), serving as an important marker for patients with significantly compromised immune status who are at risk for developing severe and visionthreatening ocular opportunistic infections. This case report describes a presentation of HIV retinopathy and cytomegalovirus (CMV) retinitis, and reviews the current management options.&#x0D; Case Report: A 40-year-old black male presented for a comprehensive eye exam to rule out HIV-related ophthalmic disease. At his initial visit, a dilated fundus examination revealed HIV retinopathy of the left eye. Upon subsequent examinations and as his immune status diminished, the patient developed CMV retinitis of the right eye. The patient was treated successfully with a course of highly active antiretroviral therapy (HAART) and oral valgancyclovir. &#x0D; Conclusion: CMV retinitis is the most common ocular opportunistic infection associated with AIDS. Treatment with systemic HAART and concomitant anti-CMV therapy leads to reconstitution of the immune system and regression of the retinitis.&#x0D;

Sida y oftalmología: una visión actual

The appearance of the Acquired Immune Deficiency Syndrome (AIDS) meant a revolution in medicine, which has also affected Ophthalmology: the routine presence of ophthalmological pathologies which until then had been exceptional, such as retinitis due to cytomegalovirus (CMV), and the appearance of other new pathologies such as progressive outer retinal necrosis (PORN). The generalised use of high activity antiretroviral therapy (HAART) in the second half of the 1990s represented a turning point, since when the immunological improvement of patients with Human Immunodeficiency Virus (HIV) resulted in a fall in the cases with ophthalmological pathology associated to immunodepression (HIV retinopathy, retinitis due to CMV, PORN...), and the spontaneous improvement of symptoms which until then had had a torpid evolution (Kaposi's ocular sarcoma, Palpebral Molluscum...). On the other hand, the continuous increase in the prevalence of syphilis in these patients means an increase in the number of cases of ocular syphilis unassociated with immunodepression. New ophthalmological alterations also appear that are related to HAART: uveitis due to immune recovery in patients with CMV retinitis in complete remission and the enophthalmos due to the atrophy of orbital fat in the context of lipodystrophy, associated with antiretrovirals. At present preventive ophthalmological checks must be carried out on patients with severe immunodepression until a count of lymphocytes above 100 cells/microl is confirmed. If they also show HIV retinopathy, a monthly check up is advisable until immune recovery, given the greater risk of infection by CMV.

Characteristics of ophthalmic symptoms in the 278 patients with human immunodeficiency virus

To investigate the characteristics of ophthalmic symptoms of patients with human immunodeficiency virus (HIV) and to provide reference for early diagnosis and treatment of HIV. The clinical data of 278 patients with HIV, including ophthalmic symptoms and general condition collected from September 2002 to July 2004, were analyzed retrospectively. These patients were from the Central African Republic. Among the 278 patients with HIV, 102 had pathologic changes in the eyes and were accompanied with chronic dissipative symptoms and decreased CD4 cell counts. The pathogen of 278 patients with HIV at the initial reception were airway infection (n = 87, 31.3%), digestive tract infection (n = 65, 23.4%), skin symptoms (n = 55, 19.8%), multiple organ failure (n = 51, 18.4%) and ophthalmic symptoms (n = 20, 7.2%). Ophthalmic symptoms manifested as opportunistic infection and sarcoma formation, such as HIV retinopathy, chronic uveitis, external ophthalmoplegia, ocular herpes, and Kaposi's sarcoma in the eyelid. HIV-related retinopathy was not specific, which manifested as retinal hemorrhage, cotton wool spots, vascular occlusion, retinal necrosis, retinal detachment and ocular nerve atrophy. Many kinds of ophthalmic symptoms might appear in patients with HIV. Severe retinopathy and uveitis are the main causes of ablepsia. Because of neglecting the ophthalmic symptoms in the early stage, many HIV patients suffer from decreased visual acuity, which may severely affect the quality of their lives. Consequently, ophthalmologists should pay more attention to patients in the early stage of HIV.

Human immunodeficiency virus–associated vision loss: electroretinogram attenuation

PURPOSE: To report a 35-year-old man with human immunodeficiency virus (HIV) and bilateral progressive decrease in vision thought to be caused by HIV optic neuropathy but associated with a severe attenuation of the electroretinogram. METHODS: Case report, review of laboratory studies, visual fields, and electroretinogram. RESULTS: Visual function deteriorated in an asymmetric fashion over 9 months of follow-up and continued to deteriorate, even when the patient had no detectable viral load. No evidence of cytomegalovirus retinitis or HIV retinopathy was present. An electroretinogram showed severe attenuation of both rod and cone-mediated functions. CONCLUSIONS: In addition to producing retinal ganglion cell axonal degeneration, HIV may also damage the other retinal elements. The progression of visual loss in the absence of detectable virus has implications for the pathogenesis and prognosis of HIV-associated vision loss.

Telemedicine diagnosis of eye disorders by direct ophthalmoscopy: A pilot study

Objective To report a pilot study of telemedical direct ophthalmoscopy in the diagnosis of acquired immune deficiency syndrome (AIDS)-related retinopathy in a human immunodeficiency virus (HIV)-positive population and in the diagnosis of glaucoma, cataract, and retinopathy in a diabetic population. Design Prospective comparative case series. Participants Seventeen HIV-positive and 20 diabetic patients. Methods A direct ophthalmoscope custom-fitted with a digital microcamera capable of transmitting images from any of 61 sites within the Georgia Statewide Telemedicine Program was used by a nonophthalmologist to examine 34 eyes of 17 HIV-positive patients and 39 eyes of 20 patients with diabetes. Fundus images were transmitted in real-time to a reviewing ophthalmologist. An in-person, comprehensive examination including indirect ophthalmoscopy, was performed by a second ophthalmologist. Telemedical examination was compared to the in-person comprehensive examination. Results For the HIV study, 21 eyes did not show HIV retinopathy (noninfectious retinopathy with cotton-wool spots) by in-person examination. Telemedical examination correctly identified 20 of these eyes as disease-free (specificity = 95%). HIV retinopathy was present in 12 of the 34 eyes by in-person evaluation with telemedical examination correctly diagnosing 10 of these eyes (sensitivity = 83%). One eye with dense cataract and retinal detachment was unable to be evaluated ophthalmoscopically by either in-person or telemedical examination. Telemedical and in-person assessments for HIV retinopathy were identical in 100% of eyes without cataract. Disagreement in diagnosis between telemedical and in-person examination was associated with cataract ( P < 0.0007). For the diabetes study, because of an inadequate image, telemedical examination was unable to classify 46% and 36% of eyes for glaucoma and diabetic retinopathy, respectively. Inability to make a telemedical determination for glaucoma ( P < 0.011), nonproliferative ( P < 0.064) and proliferative ( P < 0.064) diabetic retinopathy was associated with cataract. Of the eyes that were able to be assessed by telemedical examination for diabetic retinopathy (n = 25), glaucoma (n = 21), and cataract (n = 39), the accuracy was poor (sensitivity = 29%, 50%, and 41%, respectively). Telemedical examination for diabetic retinopathy and glaucoma was more likely to agree with in-person examination in eyes without cataract as compared to eyes with cataract (not statistically significant). Conclusion Telemedical direct ophthalmoscopic, real-time fundus imaging may provide a valuable means for providing ophthalmic consultation to the primary care physician in younger patients without lens or media opacity, but is inadequate for eyes with any degree of lens or media opacity.

Visual Changes in Human Immuno-Deficiency Virus Infection

Many Human Immuno-Deficiency Virus (HIV) patients develop ocular involvement during the course of the disease, including HIV retinopathy and cytomegalovirus (CMV) retinitis. It is well established that contrast sensitivity and color vision may be affected in other retinal diseases, such as diabetes, before obvious signs and symptoms. We therefore examined patients with early HIV disease for visual involvement. Subjects consisted of 19 HIV-positive patients and 15 controls. None of the HIV-positive patients showed any signs of HIV retinopathy. High and low contrast visual acuity, luminance contrast sensitivity (CS), short wavelength cone (S-cone) CS, and color vision were assessed in the right eye of each subject. S-cone CS was significantly reduced in the HIV-positive group (HIV mean = 0.91 +/- 0.15 log CS; normal mean = 1.10 +/- 0.09 log CS, t = 4.19, p < 0.001). Consistent with this finding, four of the HIV-positive patients demonstrated tritanopic D-15 results. High and low contrast visual acuity and CS were not significantly different in the HIV-positive and control groups. These findings indicate that HIV-positive patients can have S-cone/tritanopic abnormalities despite normal appearing fundi and that there may be damage to the visual system early in HIV infection.

Clinical manifestations of 174 AIDS cases in Maharaj Nakorn Chiang Mai Hospital.

The human immunodeficiency virus (HIV) has, since it was first reported in 1981, become a worldwide epidemic. The immunosuppressive nature of HIV results in opportunistic infections, neoplasms, and other pathological conditions. Clinical manifestations of these conditions are often the first indication that an individual is infected with HIV. This article reports and describes the clinical findings for 174 HIV-positive patients and is intended to educate Thai physicians concerning the rising HIV infection rate in Thailand. The opportunistic infectious agents included fungal, parasitic, viral, and bacterial organisms. Cryptococcosis, penicillosis, candidiasis, and histoplasmosis are fungal diseases which are discussed. Protozoal organisms and diseases covered are Pneumocystis carinii, toxoplasmosis, cryptosporidiosis, isosporiosis, and Demodex folliculorum. Bacterial infections addressed are tuberculosis, syphilis, and salmonellosis. The parasite causing nocardiosis is also discussed. Viral infections addressed are cytomegalovirus infection, herpes simplex, and hairy leukoplakia. Neoplasms or tumors discussed are Kaposi's sarcoma and non-Hodgkins lymphoma. Other pathological conditions described are brain atrophy, HIV retinopathy, and HIV wasting syndrome. In most cases, a suggested therapy regime is given for the condition discussed.

Half-Life of Cotton-Wool Spots in the Acquired Immunodeficiency Syndrome

Cotton-wool spots are a hallmark of human immunodeficiency virus (HIV) retinopathy in the acquired immunodeficiency syndrome (AIDS). We analysed the half-life of cotton-wool spots in AIDS in a prospective study, and found the average time to disappearance to be 6.9 weeks. HIV retinopathy differs from diabetic retinopathy in having a smaller size cotton-wool spot and a much shorter half-life, suggesting a patchy involvement of the retinal capillaries in AIDS and a widespread capillary disease in preproliferative and proliferative diabetic retinopathy.

Ocular Manifestations In Hiv Positive Patients Attending Khyber Teaching Hospital Peshawar

Introduction: Human immunodefi ciency virus (HIV) infection is a global health problem. Around 90% of infected persons live in developing countries, particularly those in sub-Saharan Africa and Southeast Asia. Ocular manifestations occur in approximately 70% of these patients. The objective of this study was to document ocular manifestations in HIV positive patients attending Khyber Teaching Hospital Peshawar, Pakistan. Methodology: It was a descriptive case series. The study was conducted at Khyber Teaching Hospital Peshawar from January to December 2007. A total of 14 patients were examined. These patients underwent complete ocular examination including assessment of visual acuity, pupillary reaction, ocular motility, ocular adnexa, anterior segment and posterior segment. CD4 count was done in all the patients. Results: Out of the 14 patients examined 6 (42.9%) had ocular manifestations, all of whom were male. The ocular manifestations included herpes simplex keratitis, herpes zoster ophthalmicus with neurotrophic keratitis, iridocyclitis, HIV retinopathy, retinal vasculitis and cytomegalovirus retinitis in one patient each. Amongst those with ocular manifestations, 5 patients (83.3%) had CD4 cell count of 100/mm3 or less and 1 patient (16.7%) had CD4 count between 101 and 200/mm3; and the mode of transmission was homosexual contact in 5 patients (83.3%) and vertical transmission in 1 patient (16.7%). Conclusion: Ocular manifestations occur in a considerable number of HIV positive patients particularly in those with CD4 cell count less than 100/mm3. Therefore, all HIV positive patients should be screened for ocular manifestations. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5899 SAARCTB 2011; 8(2): 31-36