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Background: HIV infection may directly and indirectly affect the eye. Infectious ocular disease associated with low CD4 count prior to antiretroviral therapy (ART) is relatively well documented, but limited data exist on occurrence of ocular conditions in HIV-infected patients using ART for extended period of time.
Methods: We recruited 342 adult participants visiting healthcare facilities in rural South Africa for HIV-related services, i.e. HIV test, pre-ART care, ART initiation or collection. We assessed occurrence of ocular conditions in four groups of individuals: HIV-uninfected (n=105), HIV-infected but not on ART (n=16), HIV-infected on ART < 12 months (n=56) and HIV-infected on ART >12 months (n=165). Demographic and clinical data were collected and full ophthalmic examination including fundoscopy was conducted. Occurrence of ocular conditions was compared between these four groups; age-adjusted odds ratio (OR) was calculated.
Results: HIV-infected individuals reported eye complaints more often (OR=1.9; 95% CI: 1.1-3.2, P=0.020) than those without HIV-infection and were more likely to have an ocular condition on examination (OR=3.1; 1.7-7.7; P< 0.001). Conditions affecting the external eye, anterior chamber or posterior chamber, but not the neuro-ophthalmic segment, were significantly more common among HIV-infected individuals (Table 1).

 HIV infected on ARTNo HIV infectionOR (95% CI)P-value
External Eye40 (17%)7 (7%)2.8 (1.6-6.6)0.015
Anterior Chamber79 (33%)18 (17%)6.5 (0.8-50)0.07
Posterior Chamber58 (24%)10 (10%)3.1 (1.5-6.4)0.001
Neuro-ophthalmic8 (8%)25 (11%)ns 
[Table 1]

Clinically detectable cataract was significantly more common in HIV-infected individuals on ART (52% vs. 16%; OR=4.3; 95% CI: 1.9-9.5, P< 0.001) than those without HIV-infection, especially among individuals using ART for more than 3 years (57%). Participants using ART for more than 3 years were more likely to have posterior eye segment conditions than those on ART for less than < 12 months (13 vs. 30%; OR=2.6; 1.0-5.0; P=0.047); in particular HIV retinopathy (1.4 vs. 10%).
Conclusions: Ocular conditions are more common among HIV-infected individuals on ART; the posterior segment is particularly affected in those using ART for extended period of time. Regular eye screening including fundoscopy may be indicated to prevent visual impairment in these individuals.

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