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Clinical Spectrum of 15 Patients with HIV-Related Ocular Involvement In

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Clinical Spectrum of 15 Patients with HIV-Related Ocular Involvement In 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 3熏晕燥援 4袁 Dec.18, 圆园10 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押陨允韵援圆园园园岳员远猿援糟燥皂 窑ClinicalResearch窑 Clinicalspectrumof15patientswithHIV-related ocularinvolvementinTehran , 1DepartmentofOphthalmology,EyeResearchCenter,Farabi andneurophthalmiclesionsarethemostcommonHIV-related Hospital,TehranUniversityofMedicalSciences,Tehran,Iran ocularinvolvementsinTehranthatisdifferentfromthoseof 2 StudentofMD/MPH,TehranUniversityofMedicalSciences, recentpublicationsindevelopedcountries. Tehran,Iran ·KEYWORDS:HIV;ocularinvolvement;highlyactiveanti- 3 DepartmentofInfectiousdiseases,IranianResearchCenterfor retroviraltherapy HIV/AIDS,TehranUniversityofMedicalSciences,Tehran,Iran DOI:10.3980/j.issn.2222-3959.2010.04.13 Correspondenceto: MohammadTaherRajabi.Departmentof Ophthalmology,EyeResearchCenter,FarabiHospital,Tehran AbdollahiA,Heidari-BateniG,ZareiR,KheirandishP,Malekmadani UniversityofMedicalSciences,Tehran,Iran.mt_rajabi@yahoo. M,MohrazM,AbdollahiM,RajabiMT.Clinicalspectrumof15 com patientswithHIV-relatedocularinvolvementinTehran. Received:2010-11-08Accepted:2010-11-30 2010;3(4):331-336 Abstract INTRODUCTION · AIM:TodeterminethefrequencyofHIV-relatedocular irstdescriptionofHIV-relatedocularinvolvementwas involvementandtodescribethecharacteristicsof F reportedmorethantwoandahalfdecadeago.Inthe involvementinaspecialclinicinTehran. earlyepidemicofAIDS,presenceofcotton-woolspotswas ·METHODS:Inthiscrosssectionalstudy,141patients(125 themostcommonophthalmicfindinginAIDSpatients. Sincethen,precisedescriptionofdifferentformofocular maleand16female,282eyes)ofHIV-infectedpatientswith involvementinHIV-infectedpatientswasmadesothat variousstagesofHIVinfectionthatwerereferredtoCenterof behavioraldiseaseswereevaluatedduringaperiodof7 nowadays,diagnosticcriteriaformanyformofocular months.Everypatienthadacompleteprofileincluding diseaseinHIVinfectedpatientshavebeenproduced. demographicdata,methodofHIVtransmission,recentCD4T SurveysonocularinvolvementofHIVwereconductedin celllymphocytecount,serologicalstudiesforcommonsexual fewstudiesaroundthedevelopingworld.Puttingthesedata orblood-bornvirusesandtoxoplasmosis,historyof togetherwiththoseofdevelopedcountriesrevealsthatthe antiretroviraltherapy,andassociatedsystemicdisease. spectrumofHIVandAIDS-relatedoculardiseasesis [1] · RESULTS:Atotalof141patientswereevaluated. differentinvariouspartsoftheworld .Forexample, CytomegalovirusRetinitisisthemostcommoncauseof HIV-relatedocularinvolvementwasdetectedin15patients retinitisinHIV-infectedpatientsin developedworld (10.6%),including3mycobacteriumtuberculosis-related choroiditis,2cytomegalovirusretinitis,2retinaltoxoplas- althoughitseemslessprevalentindevelopingcountries. mosis,2herpessimplexvirus-relatedlesions,1HIV- Ontheotherhand,aftertheintroductionofhighlyactive associatedretinopathy,1herpeszosterophthalmicus,1 anti-Retroviraltherapy (HAART),whichbecamewidely undeterminedvitritis,and3casesofcranial nerve availablein1996,clinicalfeaturesofocularinvolvement involvementincluding2casesofgazepalsyand1caseof associatedwithHIVinfectionhavebeenchangedand papilitis.Inourstudy,meanCD4Tcelllymphocytecountwas frequencyofocularinvolvement,whichaffects70to80 fewerinpatientswithocularinvolvementthaninpatients percentofallHIVinfectedpatientsatsomepointduring withoutocularinvolvement(204.7 123.8 403.7 339.7, = theirillness,decreaseddramatically.Basedonthereported 依 依 0.029),buttherewasnodifferenceinotherpossible data,theHIVepidemicinIranappearstobeacceleratingat associatedfactorsbetweentwogroups. analarmingtrend [2].Accordingtothelatestdata,about ·CONCLUSION:Mycobacteriumtuberculosis-relatedchoroiditis 66000(36000-160000)peoplearelivingwithHIVinIran, 331 HIV-relatedocularinvolvementinTehran thustheprevalencerateisabout0.2% [0.1-0.4]among SPSSversion13.Statisticalsignificancewasdeterminedby adultsaged15to49[2]. analysisandStudent's testforcategoricalandnumerical RecentattentiontoHIVepidemiologyandprogramsforcase variables,respectively. detectionandsupportivecareinIranmakeitpossibletofind RESULTS outthepatternofocularinvolvementinthisdeveloping Systemic Findings Duringthestudyperiod,141 countryintheeraofhighlyactiveantiretroviraltherapy.This HIV-infectedpatientunderwent completeophthalmic crosssectionalstudywasconductedasapartofalarger examination.Themeanage standarddeviationofpatients 依 consultingandsupportiveprogramforbehavioraldiseases, was37 9yearsandnoneofthemwasagedmorethan55 依 whichwasholdinginImamKhomeinihospitalandaimedto years.Fromthoseparticipatedinthestudy,125patientswere determinethefrequencyofocularinvolvementandto male(88.7%)and16werefemale(11.3%).Themeantime describethecharacteristicsofinvolvementsinIranian betweenophthalmic examination andHIV antibody patientswithvariousstagesofHIVinfectionreferredto detectionbyWesternblottingwas4yearsand2months centerofbehavioraldiseasesinTehran. (range:2months-16years).Twelvepatientshadactiveora MATERIALSANDMETHODS recenthistoryofpulmonarytuberculosisand52.4%of Materials DuringJun.2006toDec.2006,anycase patientshadcoinfectionwithhepatitisCvirus.Table1lists attendedtothecenterforroutineappointments,aftergiving theclinicalcharacteristicsofpatients. aninformedconsent,wasconsequentlyincludedinthe Fromallpatients,46.2%weretakinghighlyactive study.Participantswerecommittedtoattendintheeye antiretroviraltherapy(HAART)atthetimeofocular examinationprogram,whichwasheldeveryweekintheeye examinationandnoneofthepatientshaddocumentationfor clinicestablishedinthecenter.Forallofthesepatients, takingbutdiscontinuingHAARTatanytimeinthepast.At diagnosisofHIVseropositivityhadbeenprovedbya thetimeoftheeyeexamination,25ofHIV-positives positiveenzymelinkedimmunosorbentassay(ELISA)anda (17.7%)hadCD4Tlymphocytecountoffewerthan positiveimmunoblotting(Westernblot)testforHIV.All 200cells/mm3 andeightpatientshadCD4TLymphocyte patientshadamedicalrecordincludingdemographicdata, countoffewerthan100cells/mm3. methodofHIVtransmission,historyofdrugtherapy,past Accordingtothe1993CentersforDiseaseControland medicalhistoryandresultsofsystemicexaminationsfor PreventioncasesurveillancedefinitionofAIDS,39patients signsofopportunisticoranyothersystemicdisease,which wereinAIDSphase(27.6%). wascompletedineveryappointmentbyaninfectiousdisease OcularInvolvement Blurredvision(lowvision)wasthe specialist.Inaddition,serumanalysisforhepatitisCvirus commonestcomplainamongHIV-infectedpatientsandwas antibody,hepatitisBsurfaceantigen,toxoplasmaantibody seenin106eyes(37.6%).Infifteeneyeswithblurredvision, andnecessarylaboratorydataincludinghematologyand thiscomplaintconsideredtobeduetoHIV-relatedeye lymphocytesubsetanalysiswereincluded. involvement (Table2).However,refractiveerrorwasthe Methods Patientsareseenroutinelyevery3monthsandat mostcommoncauseoflowvision(84.9%).Onlyoneofthe othertimesiftheyareill.Afterobtainingthemedicalrecord, patientswithlowvisionhadcataract.Afteracompleteeye every patient underwentacompleteophthalmologic examination,ocularinvolvement,regardlessofcataractand examinationintheeyeexaminationclinic.Registeringof refractiveerrors,wasfoundin18patients(28eyes).Cellsin visualcomplainswasperformedbyatrainedeyenurseand ACandVitreousandmultiplelesionsofchoroiditiswerethe visualacuitywascheckedwithanEchartbyanoptometrist. mostcommoninvolvements(Table3).Ocularinvolvement Thenpupilsweredilatedwith10g/LTropicamideand in15patients(10.6%)wasHIV-related. 20-50g/L Phenylephrine.Twoexpertophthalmologists Oculartuberculosis(TB)wasdiagnosedin7.7%ofpatients examinedtheexternaleyeandanteriorsegmentwithaslit inAIDSphaseand2.1%amongHIV-infectedpatientsinour lamp,andthen examinedtheretinabyindirect study.Threeof12patientswithrecentorhistoryofprevious ophthalmoscopy. When there wasan ophthalmic TBreactivationhadTBocularinvolvement.Allofthemhad involvement,thepatientwasreferredtoFarabiEyeHospital CD4T-cellcountoffewerthan200cells/mm3.Oneofthem asatertiarycenterandcomplementarydiagnosticworkup wasa48year-oldmanonHAARTwithprevioushistoryof wasperformedthere.Thefrequencyanddescriptionof activeTBinfectionwhowasunderisoniazidprophylaxisand ocularinvolvementsandcomparisonofassociatedfactors withaCD4countof150cells/mm3.Theotheronewasa26 betweenpatientswitheyeinvolvementandthosewithout year-oldmanwithactiveTBinfectionwhowasonanti-TB involvementwereinvestigatedinthisstudy. treatmentregimen.HisCD4countwas123cells/mm3.The StatisticalAnalysis Analysiswasperformedbysoftware lastpatientwasa37year-oldmanwithactiveTBinfection 332 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 3熏晕燥援 4袁 Dec.18, 圆园10 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押陨允韵援圆园园园岳员远猿援糟燥皂 Table 1 Clinical and demographic characteristics of HIV-positive patients Variable With eye involvement1 Without eye involvement Total Number of patients 15 (10.6%) 126 (89.4%) 141 (100%) Mean age 34.5±9.0 37.0±8.7 36.7±8.8 Presence of a systemic infection 25.0% 13.6% 14.9% IV drug use 56.2% 50.4% 51.1% HBS antigen positive 6.2% 6.4% 6.4% HCV antibody positive 68.8% 50.4% 52.4% Toxoplasma seropositivite 31.2% 23.2% 27.2% HAART 50.0% 44% 44.7% Mean CD4 T cell count 204.7±123.8a 403.7±339.7 a 369.1±322.8 Mean Refraction Right eye -0.35±1.02 -0.26 ±1.73 -0.27±1.65 Left eye -0.39±1.09 -0.26 ±1.09 -0.28 ±1.08 1Patients with only ocular symptoms but no ophthalmic sign were categorized in patients without eye involvement. Patients with diagnosis of blepharitis, glaucoma and refractive errors were also excluded from those with eye involvement. aP = 0.029. Table 2 Frequency of ocular symptoms in 282 eyes of HIV+ patients Symptoms Right Left Total Redness 3 2 5 Pain 3 1 4 Blurred vision 55 53 106 Scotoma 3 2 5 Diplopia1 2 Purulent discharge
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