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Erol Eri Verter, Lisa Rice, Nicole Siegel; Ocular Manifestations of HIV at Boston Medical Center: A 15 Year Retrospective Study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2055.
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© ARVO (1962-2015); The Authors (2016-present)
CDC estimated that 1.2 million people aged 13 and older in the USA were infected with HIV in 2012. Despite the advent of HAART in 1996 and the drastically changing ocular manifestations of HIV, ophthalmologists should still remain aware of common ocular finding of HIV for early diagnosis of HIV and management of its ocular symptoms.
In this IRB-approved retrospective study, we catalogued the ocular manifestations of HIV patients at BMC between January 2000 and May 2015. By utilizing our electronic medical records and the billing code for HIV, we recruited subjects who visited our ophthalmology department after their HIV diagnosis. Among this pool, we searched for related billing codes for known ocular diseases associated with HIV. CD4 counts, viral loads and documented compliance with HAART, were recorded by reviewing the infectious disease physicians’ notes within three months of the diagnosis of the ocular finding.
A total of 1239 patients were identified, 59% male and 41% female. The racial demographics included 61% African American, 15% Caucasian, 5% Hispanic and 19% defined as other. The most common associated diagnoses were iridocylitis NOS (5.5%), chorioretinitis NOS (5.2%) and retinal hemorrhages (2.3%). At the time of ocular diagnosis, 75% of subjects had CD4 counts less than 500 cells/mm. However, as expected, 78% of patients with CMV retinitis had CD4 counts less than 200 at the time of diagnosis versus 37% overall (p=0.01). According to the ID notes, 56% were compliant with HAART. Compared to the pre-HAART era, CMV retinitis rates decreased from 30-40% to 1.6% (p=0.001) after the introduction of HAART therapy. Of those with CMV retinitis only 18% were compliant with HAART (p= 0.03). The rates of HZO dropped significantly from 5% in the pre-HAART era to 1.4% (p=0.02) after the advent of HAART, with 83% of patients having CD4 counts less than 500 and 62% deemed non-compliant with HAART.
Our study implicates the declining nature of ocular manifestations of HIV since the advent of HAART, as well as revisits the changing paradigm of HIV related ocular diseases. We do however realize possible under diagnosis due to billing code bias, patient noncompliance, as well as visits to outside institutions.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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