Abstract
Purpose: :
To characterize and correlate ocular findings in HIV positive patients with CD4 count
Methods: :
The medical records of patients with a history of HIV who were admitted to the inpatient wards or the emergency room and evaluated by the ophthalmology consult service at Howard University Hospital between October 2008 and November 2010 were reviewed. CD4 counts and antiretroviral therapeutic regimens were recorded for each patient. Best corrected visual acuity; intraocular pressure; pupil, anterior segment and posterior segment exam findings; and ophthalmic diagnoses were recorded for both eyes of each patient. Descriptive statistics were performed using Microsoft EXCEL 2008 for MAC version 12.2.7 (Microsoft Corporation, Redmond, Washington). Exam findings were compared for individuals receiving Highly Active Antiretroviral Therapy (HAART) versus those who were not and for individuals who met the diagnostic criteria for AIDS, defined as a CD4 count < 200.
Results: :
A total of 83 patient records which included 164 eyes were reviewed. There were 47 men and 36 women. The mean age was 44 with a range of 23 to 77. Fifty patients were black, one Hispanic and one Caucasian. Race and ethnicity data were absent from 31 records. CD4 counts were recorded on 60 patients which included 119 eyes and only 35 patients were receiving HAART. Overall, 71% of all patients had at least one ophthalmic diagnosis. Twenty percent of eyes were diagnosed with HIV retinopathy, 7.3% were glaucoma suspects, 6.7% had dry eye syndrome, 4.3% had anterior uveitis, 4.9% had CMV retinitis, 3.7% had herpes zoster ophthalmicus, 3.6% had blepharitis, and 3% had conjunctivitis. The average intraocular pressure of patients on HAART was 12.8 mm Hg and for those not on HAART was 15.1 mm Hg. In those patients who met the diagnostic criteria for AIDS, 25% of eyes had HIV retinopathy whereas in those with a CD4 count ≥200, only 6.25% had HIV retinopathy. The leading diagnosis in AIDS patients was HIV retinopathy, and in those with CD4 counts of ≥200, it was anterior uveitis (10.4%).
Conclusions: :
The majority of inpatients and emergency room patients with HIV were diagnosed with at least one ophthalmic disease. HIV retinopathy was the leading cause of ocular morbidity amongst those patients with AIDS.
Keywords: AIDS/HIV • clinical (human) or epidemiologic studies: prevalence/incidence • clinical (human) or epidemiologic studies: natural history