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D.A. Gill, R.M. Lieberman, K. Ramonas, K. Doan, A. Young, M. Fabbri; Changing Patterns of Initial Ophthalmic Presentations in HIV . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1667.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate and determine the relative frequencies of initial ophthalmic processes which represent the presenting manifestation of newly diagnosed HIV disease in patients treated at a city hospital's infectious disease clinic over a six–month period. Design: Retrospective, non– randomized Methods: The medical records of 58 consecutive HIV–positive patients were evaluated for primary clinical diagnoses at the time of their presentation to the clinic. Of these patients, 34 were newly diagnosed with HIV infection. The results were analyzed for percentage of ophthalmic disease as the presenting manifestation in the newly diagnosed patients. In addition, specific infectious etiologies were identified. CD–4 counts were noted. Results: Four, or 6.9%, of all patients (58) were diagnosed as having a posterior uveitis. These same 4 patients, or 11.7% of the newly diagnosed cohort (34), had presented with posterior uveitis as their presenting complaint. This ophthalmic diagnosis led to the determination of their HIV status. The infectious etiologies were as follows: 1 cytomegalovirus retinitis, 2 syphilis, and 1 tuberculosis. The CD–4 counts of these four patients ranged from 21–534. Conclusions: A review of the literature suggests that, prior to the availability of HAART, up to 50% of patients had ophthalmic changes associated with their HIV infection, the vast preponderance being microangiopathy and CMVR. Other posterior uveitities (syphilis, toxoplasmosis, TB, and others) accounted for less than 5%. However, the percentage of patients with ophthalmic disease as their presenting manifestation was markedly less. As the patients in this study are HAART naïve, they should be analogous to patients from that era, specifically with respect to the type and distribution of ophthalmic diseases seen. However, our series suggests a possible shift in the etiologies of posterior uveitis in newly diagnosed HIV patients. This may be due to differences such as demographics, increased surveillance, and proactive intervention, all of which may contribute to the observed shift in etiologies. The relative increase in syphilitic uveitis, as opposed to other infectious etiologies, may correlate with a nationwide increase in this disease.
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