aids and eye

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AIDS and EYE

Gilbert WS Simanjuntak

Dept. of Ophthalmology School of Medicine

Christian University of Indonesia

Jakarta, Indonesia

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no financial interest in itemsdiscussed

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HIV itself has been isolated from tears,

conjunctiva, cornea, aqueous humor, iris, sclera,

vitreous humor, and retina



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OCULAR MANIFESTATIONS OF HIV INFECTIONTrans Am Ophthalmol Soc. 1995

1163 patients were seen for ophthalmologicevaluation.

781 had the acquired immune deficiency

syndrome (AIDS)

226 had symptomatic HIV infection (AIDs-related

complex [ARC

156 had asymptomatic HIV infection.

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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

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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 orworse 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-ophthalmiclesion 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/µl

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Infectious uveitis in immunocompromisedpatients 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 inImmunocompromised PatientsAqueous Analysis (Am J Ophthalmol 2007)

Of 56 immunocompromised patients

43 (77%), all posterior and panuveitis, had intraocularinfections. Twenty-one (49%) had CMV, three (7%) hadVZV, 11 (26%) had T. gondii , six (14%) had Treponema pallidum , and one (2%) each had Aspergillus andCandida .

In AIDS patients, CMV was the most common cause. Astrong correlation between AIDS and ocular syphilis wasalso observed (P .007).

In non-AIDS immunocompromised patients, T. gondii wasmost 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 drugsDuring the first few months of therapy, most

patients on HAART experience a rise in CD4+ T-

lymphocyte numbers

This response can occur even in patients with advanceddisease.

With HAART, there is a reduction in the number ofopportunistic infections

HIV resistance to the drugs can develop with prolongeduse.

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Failure of HAART may eventually result in the re-

emergence 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 virusHSV Keratitis : oral antiviral, epithelial

debridement with topical antiviral

Bacterial : as per culture/sensitivity test

CMV Retinitis : intravitreal antiviral



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Pneumocysticchoroiditis

Cryptococcusinvolvement of opticnerve and retina

Multiple choroidaltubercles due to oculartuberculosis

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Intravitreal injection

THANKTHANKYOUYOU

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