Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Background. The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live longer, enabling us to observe the long-term effects of HIV and HAART on the eye. There are few recent studies on HIV-re...
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| Format: | Article |
| Language: | English |
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South African Medical Association
2023-10-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/950 |
| _version_ | 1827359417438306304 |
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| author | I Ismail M Venter S Ismail N Ally |
| author_facet | I Ismail M Venter S Ismail N Ally |
| author_sort | I Ismail |
| collection | DOAJ |
| description |
Background. The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live longer, enabling us to observe the long-term effects of HIV and HAART on the eye. There are few recent studies on HIV-related ocular disease in sub-Saharan Africa.
Objectives. To describe the ocular manifestations of HIV in patients attending the Nthabiseng HIV clinic at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Methods. A cross-sectional study was conducted in 2021 and 2022 using convenience sampling of patients at the HIV clinic. The participants’ clinical history was taken, their files were reviewed, and they underwent ocular examination. Correlation between eyes was managed by taking disease in one eye as the presence of disease in the participant. Descriptive statistics were used to summarise participant characteristics. Univariate and multivariate logistic regression models were used to assess the odds ratio (OR) of developing HIV-associated ocular diseases, and a p-value of <0.05 was used to define statistical significance.
Results. There were 182 participants (139 females and 43 males), with a mean (standard deviation) age of 48.9 (10.6) years. The most common anterior segment diagnoses were conjunctival microangiopathy (34.6%), pinguecula (31.3%) and cataracts (30.2%), while the most common posterior segment finding was peripheral retinal scarring with features in keeping of previous cytomegalovirus retinitis (24.2%). Notably, only 1.1% of patients had HIV retinopathy. A CD4 count <200 cells/μL showed an increased OR for cataracts (OR 4.24; p=0.003) and any anterior segment diagnoses (OR 10.05; p=0.029), while a CD4 count ≥200 cells/μL showed an increased risk of conjunctival microangiopathy (OR 2.14; p=0.017).
Conclusion. With the advent of HAART, ocular manifestations of HIV are changing and the incidence of severe ocular opportunistic infections and HIV retinopathy has decreased precipitously. Although this study has shown that patients with a CD4 count <200 cells/μL are at increased risk of developing anterior ocular manifestations of HIV, including cataracts, these diseases are relatively innocuous or easily treatable. Routine ocular screening of HIV patients seems to be substantially less important now than it was in the pre-HAART era.
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| first_indexed | 2024-03-08T06:28:42Z |
| format | Article |
| id | doaj.art-d33df0a9384c46a2b00fd5fcb292f9e5 |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T06:28:42Z |
| publishDate | 2023-10-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-d33df0a9384c46a2b00fd5fcb292f9e52024-02-03T13:01:33ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352023-10-011131010.7196/SAMJ.2023.v113i10.950Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South AfricaI Ismail0M Venter1S Ismail2N Ally3Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDivision of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaConsultant ophthalmologist, Johannesburg, South AfricaManchester Royal Eye Hospital, Manchester, UK; Division of Ophthalmology, Department of Neurosciences, St John Eye Hospital, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Background. The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live longer, enabling us to observe the long-term effects of HIV and HAART on the eye. There are few recent studies on HIV-related ocular disease in sub-Saharan Africa. Objectives. To describe the ocular manifestations of HIV in patients attending the Nthabiseng HIV clinic at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Methods. A cross-sectional study was conducted in 2021 and 2022 using convenience sampling of patients at the HIV clinic. The participants’ clinical history was taken, their files were reviewed, and they underwent ocular examination. Correlation between eyes was managed by taking disease in one eye as the presence of disease in the participant. Descriptive statistics were used to summarise participant characteristics. Univariate and multivariate logistic regression models were used to assess the odds ratio (OR) of developing HIV-associated ocular diseases, and a p-value of <0.05 was used to define statistical significance. Results. There were 182 participants (139 females and 43 males), with a mean (standard deviation) age of 48.9 (10.6) years. The most common anterior segment diagnoses were conjunctival microangiopathy (34.6%), pinguecula (31.3%) and cataracts (30.2%), while the most common posterior segment finding was peripheral retinal scarring with features in keeping of previous cytomegalovirus retinitis (24.2%). Notably, only 1.1% of patients had HIV retinopathy. A CD4 count <200 cells/μL showed an increased OR for cataracts (OR 4.24; p=0.003) and any anterior segment diagnoses (OR 10.05; p=0.029), while a CD4 count ≥200 cells/μL showed an increased risk of conjunctival microangiopathy (OR 2.14; p=0.017). Conclusion. With the advent of HAART, ocular manifestations of HIV are changing and the incidence of severe ocular opportunistic infections and HIV retinopathy has decreased precipitously. Although this study has shown that patients with a CD4 count <200 cells/μL are at increased risk of developing anterior ocular manifestations of HIV, including cataracts, these diseases are relatively innocuous or easily treatable. Routine ocular screening of HIV patients seems to be substantially less important now than it was in the pre-HAART era. https://samajournals.co.za/index.php/samj/article/view/950HIVEyeOcular diseaseCataractHIV retinopathyAntiretroviral Therapy |
| spellingShingle | I Ismail M Venter S Ismail N Ally Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa South African Medical Journal HIV Eye Ocular disease Cataract HIV retinopathy Antiretroviral Therapy |
| title | Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa |
| title_full | Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa |
| title_fullStr | Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa |
| title_full_unstemmed | Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa |
| title_short | Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa |
| title_sort | ocular manifestations of hiv infection at chris hani baragwanath academic hospital johannesburg south africa |
| topic | HIV Eye Ocular disease Cataract HIV retinopathy Antiretroviral Therapy |
| url | https://samajournals.co.za/index.php/samj/article/view/950 |
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