Abstract
Purpose :
To compare the acute and chronic manifestations of Stevens-Johnson Syndrome(SJS) and Toxic Epidermal Necrolysis (TEN) in an HIV-positive and HIV-negative population of patients.
Methods :
This retrospective review evaluated all SJS/TEN patients within the Research Patient Data Registry of the Mass General Brigham healthcare system with and without HIV-infection. Patients were required to have relevant documentation of acute ocular manifestations as well as at least one chronic follow up visit ≥ 3 months post-discharge. Main outcome measures for acute ocular outcomes were acute ocular Sotozono score (AOSS), and for chronic ocular outcomes were severe ocular complications (SOC), chronic ocular Sotozono score (COSS), and best corrected visual acuity (BCVA) as measured using LogMAR VA.
Results :
Seventeen patients were reported in the HIV-positive (HIV+) group and 181 patients reported in the HIV-negative (HIV-) group. HIV+ patients had a higher frequency of TEN in comparison to the HIV- patients (P = 0.003). However, HIV- patients had a higher AOSS compared to those who were HIV+ (P = 0.010). Zero of 17 HIV+ patients required AMT therapy whereas 50 of 181 HIV- patients required AMT therapy (P = 0.008). Chronic ocular data was present for only 6 of the 34 eyes of HIV+ patients. Severe ocular complications (SOC) occurred more frequently in the HIV+ group than the HIV- group before and after controlling for AOSS (P < 0.0001). LogMAR VA was better in the HIV+ group relative to the HIV- group before controlling for AOSS (P = 0.004) and was equivalent after controlling for AOSS (P = 0.383). Cornea, conjunctiva, eyelid margin, and total COSS were not significantly different between groups before and after controlling for AOSS.
Conclusions :
Despite having more severe systemic presentation of SJS/TEN, HIV-positive patients had less severe acute ocular disease than HIV-negative patients and required less AMT therapy. However, chronic ocular disease was worse in those who were HIV positive. This finding may be due to a different and/or suppressed immune mechanism of disease in those with HIV positivity, or a smoldering and longer acute or subacute disease phase and requires further study. Future studies are indicated to determine the pathophysiology of acute disease in HIV positive SJS/TEN patients and whether there should be a lower threshold to perform AMT.
This is a 2021 ARVO Annual Meeting abstract.