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Xiangrong Kong, Stephanie Irwin, Joseph Ssekasanvu, Beatriz E Munoz, Sheila K West, Gertrude Nakigozi; Assessment of visual impairment and eye diseases in HIV-infected people in the ART era in Rakai, Uganda. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4108.
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© ARVO (1962-2015); The Authors (2016-present)
Eye diseases (EDs) due to opportunistic infections were common in HIV+ people in the pre/early antiretroviral therapy (ART) era. The wide use of ART has significantly reduced infectious EDs, but the longer survival of HIV+s increases their risks of age related EDs and visual impairment. There are limited data on EDs in the current ART era in sub-Saharan Africa. We report the spectrum of EDs in adult HIV+s observed in an ophthalmic service camp conducted in 2009-12 in Rakai district in southwestern Uganda where HIV prevalence ~14%.
Through mobilization in local HIV care clinics, HIV+s were encouraged to participate visual screening service provided by a trained clinical staff in the HIV clinics. A 6-meter Snellen chart was used to assess unilateral presenting visual acuity (VA). Abnormal findings were further evaluated by an ophthalmologist using a slit lamp. Data for this analysis were abstracted from the screening and ophthalmic evaluation records. Visual impairment (VI) was defined referencing WHO International Classification of Disabilities (ICD 10) as: no VI if the better seeing VA no worse than 20/25, mild VI if 20/25-20/70, moderate VI if 20/70-20/200, severe VI if 20/200-20/400, and blind if worse than 20/400.
There were 683 adult HIV+s (69% female) participated the ophthalmic service, median age 44 IQR 37-50, range 18-80 years. Majority (60%) were on ART with a median duration of 3 (IQR 1-5) years. Prevalence of mild, moderate and severe VI and blindness was 17%, 2%, 0% and 2%, respectively. Table 1 lists the full spectrum of EDs identified. The main pathologies were refractive error (prevalence 55%), conjunctivitis (18%), cataract (15%), and pterygium (11%). Cataract was found in 82% of the HIV+s with blindness, and in 70% of those with moderate VI. In HIVs+ with mild VI, 60% had refractive error, and 30% had cataract. Older age was significantly associated with higher prevalence of cataract (p<.001. 9% in 18-34 years old, 12% in 35-49 years old, and 26% in 50+ years old).
VI was common in HIV+s in the ART era in Rakai. Main reasons for VI were refractive error and cataract. Cataract prevalence was higher with older age in HIV+s. Incorporating visual screening service and providing glasses in HIV clinics may be a venue to improving general functioning of HIV+s and may increase access to HIV care and treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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