Ocular manifestations in HIV-infected individuals

  • Darja Dobovšek Divjak Očesna klinika Ljubljana Univerzitetni klinični center Ljubljana Grablovičeva 46 1000 Ljubljana
  • Rok Grčar Center za očesne bolezni in motnje vida Irman d.o.o. Štihova 9 1000 Ljubljana
  • Nataša Vidović Valentinčič Očesna klinika Ljubljana Univerzitetni klinični center Ljubljana Grablovičeva 46 1000 Ljubljana
Keywords: immune defciency, ophthalmic evaluation, CD4 T-cells, opportunistic infections, antiretroviral therapy

Abstract

Ocular manifestations may be the frst sign of disseminated systemic HIV infection in HIV-infected individuals. Terefore, it is of the utmost importance to early diagnose ocular conditions that are not responsive to conventional ophthalmic treatment. HIV-related ocular manifestations can affect the anterior (e.g. neoplasia and periocular tissue infections) as well as the posterior segment of the eye (e.g. retinopathy and opportunistic infections of the retina and choroid). Studies confrm that approximately 70 % of all HIV-infected patients suffer from at least one ocular manifestation caused by the HIV infection, so regular ophthalmic examinations are necessary in order to early diagnose and treat the disease, which might improve prognosis of the patient and prevent vision loss.

In the frst part of the article we present some of the most common HIV-related ocular manifestations, while the second part of the article includes our experience in ophthalmic evaluation, followup and treatment recommendations.

Downloads

Download data is not yet available.

References

Kuhar DR, Henderson DK, Struble KA, Heneine W, Tomas V, Cheever LW, et al. Updated US Public Health Service Guidelines fot the Management of Occupational Exposured to Human Immunodefciency Virus and Recommednations for Postexposure Prophylaxis. Infect Control Hosp Epidemiol. 2013; 34(9): 875–92.

Schneider E, Whitmore S, Glynn MK, Dominguez K, Mitsch A, McKenna MT; et al. Revisied surveillance case defntions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years-United States, 2008. MMWR Recomm Rep. 2008; 57(RR-10): 1–12.

Kaplan JE, Hanson D, Dworkin MS, Frederick T, Bertolli J, Lindegren ML, et al. Epidemiology of Human Immunodefciency Virus-Associated Opportunistic Infections in the United States in the Era of Highly Active Antiretroviral Terapy. Clin Infect Dis. 2000; 30 Suppl 1:S5–14.

Klavs I, Kustec T. Okužba s HIVv Sloveniji: letno poročilo 2014. Nacionalni Inštitut za javno zdravje 2015; 1[ 30.1.2016]. Available from: http://www.nijz.si/epidemiolosko-spremljanje-nalezljivih-bolezni-letna-porocila.

Murray JM, Zaunders JJ, McBride KL, Xu Y, Bailey M, Suzuki K, et al. HIV DNA Subspecies Persist in both Activated and Resting Memory CD4+ T Cells during Antiretroviral Terapy. J Virol. 2014; 88(6): 3516–26.

Bakanda C, Birungi J, Mwesigwa R, Ford N, Cooper CL, Au-Yeung C, et al. Association of aging and survival in a large HIV-infected cohort on antiretroviral therapy. AIDS. 2011; 25(5): 701–5.

Cole SR, Hudgens MG. Survival analysis in infectious disease research: describing events in time. AIDS. 2010; 24(16): 2423–31.

Ewings FM, Bhaskaran K, McLean K, Hawkins D, Fisher M, Fidler S, et al. Survival following HIV infection of a cohort followed up from seroconversion in the UK. AISD. 2008; 22(1): 89–95.

Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B. Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS. 2004; 18(10): 1429–33.

Ocular Involvement in AIDS. In: American academy of Ophthalmology. Intraocular Inflammation and Uveitis. United States of America. 2015. p. 198–202, 293–301.

Jabs DA, Van Natta ML, Hollbrook JT, Kempen JH, Meinert CL, Davis MD. Longitudional study of the ocular complications of AIDS. Ophthalmology. 2007; 114(4): 787–93.

Holland GN. AIDS and Ophthalmology: the frst quarter century. Am J Ophthalmol. 2008; 145(3): 397–408.

Wu Z, Rou K, Jia M, Duan S, Sullivan SG. The first community-based sexually transmitted disease/HIV intervention trial for female sex workers in China. AIDS. 2007; 21 Suppl 8:S89–94.

Dadgostar H, Holland GN, Huang X, Tufail A, Kim A, Fisher TC, et al. Haemorheologic abnormalities associated with HIV infection: in vivo assesment of retinal microvascular blood flow. Invest Ophthalmol Vis Sci. 2006; 47(9): 3933–8.

Kalyani PS, Fawzi AA, Gangaputra S, Natta ML, Hubbard LD, Danis RP, et al. Studies of the Ocular Complications of AIDS Research Group. Retinal vessel caliber among people with acquired immunodefciency syndrome: relationship with visual function. Am J Ophthalmol. 2012; 153(3): 428–33.

Brun SC, Jakobiec FA. Kaposi’s sarcoma of the ocular adnexa. Int Ophthalmol Clic. 1997; 37(4): 25–38.

Neoplastic Disorders of the Conjunctiva and Cornea. American Academy of Ophthlamology. External Disease and Cornea. San Francisco: American Academy of Ophthalmology; 2015. p. 231

Qureshi YA, Karp CL, Dubovy SR. Intralesional interferon alpha-2b therapy for adnexal Kaposi sarcoma. Cornea. 2009; 28(8): 941–3.

Galor A, Karp CL, Chhabra S, Barnes S, Alfonso EC. Topical interferon alpha 2b eye-drops for treatment of ocular surface squamous neoplasia: a dose comparison study. Br J Ophthalmol. 2010; 94(5): 551–4.

Karp CL, Scott IU, Chang TS, Pflugfelder SC. Conjunctival intraepithelial neoplasia. A possible marker for human immunodefciency virus infection? Arch Ophthalmol. 1996; 114(3): 257–61.

Baker PS, Gold KG, Lane KA, Bilyk JR, Katowitz JA. Orbital Burkitt lymphoma in immunocompetent patients: a report of 3 cases and a review of the literature. Ophthal Plast Reconstr Surg. 2009 25(6): 464–8.

Blum KA, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood. 2004 15; 104(10): 3009–20.

Te herpetic eye disease study group. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med. 1998; 339(5): 300–6.

Sellitti TP, Huang AJ, Schiffman J, Davis JL. Association of herpes zoster ophthalmicus with acquired immunodefciency syndrome and acute retinal necrosis. Am J Ophthalmol. 1993; 116(3): 297–301.

Hodge WG, Seiff SR, Margolis TP. Ocular opportunistic infection incidences among patients who are HIV positive compared to patients who are HIV negative. Ophthalmology. 1998; 105(5): 895–900.

Kronish JW, Johnson TE, Gilberg SM, Corrent GF, McLeish WM, Scott KR. Orbital infections in patients with human immunodefciency virus infection. Ophthalmology. 1996; 103(9): 1483–92.

Davis JL, Hummer J, Feuer WJ. Laser photocoagulation for retinal detachments and retinal tears in cytomegalovirus retinitis. Ophthalmology. 1997; 104(12): 2053–60.

Amabati J, Wynne KB, Angerame MC, Robinson MR. Anterior uveitis associated with intravenous cidofovir use in patients with cytomegalovirus retinitis. Br J Ophthalmol. 1999; 83(10): 1153–8.

Gomez ML, Mojana F, Bartsch DU, Freeman WR. Imaging of long-term retinal damage afer resolved cotton wool spots. Ophthalmology. 2009; 116(12): 2407–14.

Holland GN, Vaudaux JD, Shiramizu KM, Yu F, Goldenberg DT, Gupta A, et al. Characteristics of untreated AIDS-related cytomegalovirus ritinitis. II. Findings in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2008; 145(1): 12–22.

Weiner G, Heiden D, Holland GN, Keenan JD. HIV-related CMV retinitis in the developing world. EyenetMagazine 2014; (27–29) [cited 1.12.2016]. Available from: https://www.aao.org/eyenet/article/hivrelated-cmv-retinitis-in-developing-world.

Stewart MW. Optimal management of cytomegalovirus retinitis in patients with AIDS. Clin Ophthalmol. 2010; 4: 285–99.

Kedhar SR, Jabs DA. Cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Herpes. 2007; 14(3): 66–71.

Jabs DA. Cytomegalovirus retinitis and the acquired immunodefciency syndrome. Am J Ophthalmol. 2011; 151(2): 198–216.

Chee SP, Bascal K, Jap A, Se-Toe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008; 145(5): 834–840.

Segarra-Newnham M, Salazar MI. Valganciclovir: A new oral alternative for cytomegalovirus retinitis in human immunodefciency virus-seropositive individuals. Pharmacotherapy. 2002; 22(9): 1124–8.

Martin DF, Kuppermann BD, Wolitz RA, Palestine AG, Li H, Robinson CA. Oral ganciclovir for patients with cytomegaloviru retinitis treated with a ganciclovir implant. N Engl J Med. 1999; 340(14): 1063-70.

Jabs DA, Holbrook JT, Van Natta ML, Clark R, Jacobson MA, Kempen JH, et al. Studies of ocular complications of AIDS research group. Ophthalmology. 2005; 112(5): 771–9.

Jabs DA, Martin BK, Forman MS. Mortality associated with resistant cytomgelovirus among patients with cytomegalovirus retinitis and AIDS. Ophthalmology. 2010; 117(1): 128–32.

Whitcup SM, Fortin E, Lindblad AS, Grifths P, Metcalf JA, Robinson MR, et al. Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis. JAMA. 1999; 282(17): 1633–7.

Kuppermann BD, Holland GN, Immune recovery uveitis. Am J Ophthalmol. 2000; 130(1): 103–6.

Kempen JH, Min YI, Freeman WR, Holland GN, Friedberg DN, Dietrich DT, et al. Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis. Ophthalmology. 2006; 113(4): 684–94.

Schrier RD, Song MK, Smith IL, Karavellas MP, Bartsch DU, Torriani FJ, et al. Intraocular viral and immune pathogenesis of immune recovery uveitis in patients with healed cytomegalovirus retinitis. Retina. 2006; 26(2): 165–9.

Karavellas MO, Plummer DJ, Macdonald JC, Torriani FJ, Shufelt CL, Azen SP, et al. Incidence of immune recovery vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy. J Infect Dis. 1999; 179(3): 697–700.

Moshfeghi DM, Dodds EM, Couto CA, Santos CI, Nicholson DH, Lowder CY, et al. Diagnostic approaches to severe, atypical toxoplasmosis mimicking acute retinal necrosis. Ophthalmology 2004; 111(4): 716–25.

Kim SJ, Equi R, Belair ML, Fine HF, Dunn JP. Long-term preservation of vision in progressive outer retinal necrosis treated with combination antiviral drugs and highly active antiretroviral therapy. Ocul Immunol Inflamm. 2007; 15(6): 425–7.

Browning DJ. Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicilin therapy, and the influence of human immunodefciency virus status on response. Ophthalmology. 2000; 107(11): 2015–23.

Kestelyn P, Taelman H, Bogaerts J, Kagame A, Abdel AM, Batungwanayo J, et al. Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodefciency syndrome. Am J Ophthalmol. 1993; 116(6): 721–7.

Gellrich MM, Lagreze WD, Rump JA, Hansen LL. Indications for eye examinations of HIV patients – screening parameters for cytomegalovirus retinitis. Klin Monbl Augenheilkd. 1996; 209(2–3): 72–8.

Published
2017-01-15
How to Cite
1.
Divjak D, Grčar R, Valentinčič N. Ocular manifestations in HIV-infected individuals. TEST ZdravVestn [Internet]. 15Jan.2017 [cited 20Apr.2024];85(11-12):664-75. Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1532
Section
Professional Article