AEGiS-13IAC: Ophthalmic manifestations in HIV/AIDS patients on highly active antiretroviral therapy.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Ophthalmic manifestations in HIV/AIDS patients on highly active antiretroviral therapy.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThPeB5257)

Tubonye HC, Narayanan K, Cliffe A, Hurley C
H. C. Tubonye, Bure Clinic, James Paget Healthcare NHS Trust, Great Yarmouth NR31 6LA, United Kingdom, Tel.: +44 1493 452 747, Fax: +44 1493 452 864, E-mail: tcharry@bureclinic.com

BACKGROUND: There has been decline in the morbidity and mortality of HIV/AIDS patients on highly active antiretroviral therapies (HAART). Some authorities now advocate discontinuation of maintenance therapy for CMV retinitis for patients on HAART. This study was undertaken to analyse the effect of HAART on the incidence and prevalence of ophthalmic manifestations in our cohort of HIV/AIDS patients managed jointly by the Ophthalmologists and HIV Physician in a 520-bed district general hospital in England.

METHODS: Retrospective study of our cohort of 20 HIV/AIDS patients cared for jointly in the Bure Clinic and Ophthalmology Department from 1996 to 1999. We serve a catchment population of 250,000 in Great Yarmouth. Twenty case notes were manually retrieved and cross-referenced. The patients underwent serial ophthalmic examinations at 3 monthly intervals. All patients had CD4+ counts and HIV-1 RNA viral load at 3 monthly intervals, including genotypic viral resistance and drug level monitoring when needed.

RESULTS: There were 5 females, mean age (years) 38.80 é 11.30 range (23-50) and 15 males mean age (years) 41.67 é 11.05 range (23-59). The locality prevalence of HIV/AIDS was 17 per 100,000-population aged 15-64 years. Seven patients had asymptomatic HIV infection, 1 female and 6 males. Four had symptomatic HIV infection, 3 females and I male. Nine had AIDS, 1 female and 8 males. The risk factors: 8 Homosexual, 2 homosexual & Intravenous drug user (IVDU), 3 males (heterosexual acquired in sub-Saharan Africa), 1 male heterosexual acquired in the United Kingdom and 1 male indeterminate. Three females were heterosexual acquisition (1 from Louisiana, USA) and 2 females were IVDU's. Ophthalmic examination and follow-up was over a mean of 20.5 months range (1-48) months. Eighteen of the 20 (90%) patients received various combinations of nucleoside reverse transcriptase inhibitors (Combivir, Lamivudine, Stavudine ), non-nucleoside reverse transcriptase inhibitors (Delavirdine, Nevirapine, Efavirenz ) and protease inhibitors (Indinavir, Nelfinavir, Soft gel Saquinavir ). Of the 16 patients who underwent serial ophthalmic examination, only one had HIV microvasculopathy, which resolved spontaneously. No other patients showed any other ophthalmic manifestations of HIV disease. The mean CD4+ count was 367.95 cells/mm³ , range (20-1000) and mean HIV-1 RNA viral load was 3.28 log 10, range (>1.69-6.43 log₁₀ ). Seven patients, 2 females and 5 males had undetectable viral load less than 1.69 log₁₀ (>50 copies/ml) NASBA Roche Assay.

CONCLUSIONS: Extensive use of highly active antiretroviral therapy combined with regular ophthalmic assessment by an Ophthalmologist, is essential in the management of HIV/AIDS patients to detect ocular manifestations of HIV infection. In our cohort, use of HAART is associated with prevention of ophthalmic complications even in those with extremely low CD4 counts and high viral load.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, HIV, HIV Infections, Acquired Immunodeficiency Syndrome, CD4 Lymphocyte Count, Viral Load, Cytomegalovirus Retinitis, Anti-HIV Agents, HIV Seropositivity, Nelfinavir, Saquinavir, Prevalence, Indinavir, Protease Inhibitors, Retrospective Studies, England, Great Britain, Africa South of the Sahara, Louisiana, Human, Female, Male
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ThPeB5257