Introduction

Human immunodeficiency virus causes chronic, potentially life threatening condition. HIV interferes with immunity that is ability of body to fight with organism that causes disease by damaging immune system.

Since its discovery in 1981, human immunodeficiency virus/ acquired immunodeficiency syndrome has emerged as a global health problem. According to WHO latest data of 2017, globally, 36.9 million people living with HIV. Upto 50-75% of HIV/AIDS patients present with ocular manifestation in their life time. It can involve any part of eye from anterior segment, posterior segment, and even adnexa. CD4 count less than 500 cells/mm3 is seen with Kaposi sarcoma, lymphoma and tuberculosis and Counts less than 250 cells/mm3 are associated with Pneumocystis and Toxoplasma infections, and counts of less than 100cells/mm3 with microvasculopathy, CMV retinitis, varicella zoster retinitis, cryptococcus and HIV encephalopathy. Herpes zoster ophthalmicus is an important early clinical marker for AIDS especially in high risk younger patients.

Increasing use of ART is improving the survival of AIDS patients and changing the scenario of ocular manifestations. Since HIV/AIDS is disease of young individual who are economically and sexually active, early diagnosis and treatment of ocular lesion prevents permanent loss of vision, so that person earns his livelihood and independent life.

Keeping this in view, this study has been undertaken and present work aims at evaluating the ocular manifestation of HIV and relation with CD4 count.

Objectives

Materials and Methods

This study was hospital based cross sectional study of HIV positive patient presenting to out patient department of tertiary eye care hospital in rural area. DESIGN: Cross sectional study.

Observation and Results

The present study was conducted on 400 HIV positive patients with HIV positive reports. The data was tabulated as follows:

Our study found sexual route as the most common mode of transmission of HIV seen in 66.5% of patients, of which heterosexual was the most common mode seen in 240 patients (60%).

Our study showed the prevalence of ocular manifestations among HIV positive patients as 39%.

In our study, the majority of HIV infected patients with CD4 count less than 100 has ocular manifestations i.e., 14 patients (87.5%) out of 16 with CD4+ T cell counts < 50 cells /ml and 32 patients (80%) out of 40 with CD4 count between 51- 100.

Chisquare analysis was done which showed significant correlation (p = 0.001) between ocular manifestations in HIV and lower CD4+ T cell counts.

In the present study, adnexa of eyes involved in total 31 patients of HIV/ AIDS (7.75%). In the present study, anterior segment manifestations were more common compared to posterior segment manifestations in HIV / AIDS patients. Posterior segment manifestations of HIV/AIDS were seen in 43 patients out of 156 patients with ocular involvement (27.56%). The most common ocular manifestation of posterior segment in HIV patients in our series was HIV retinopathy (18 patients) followed by CMV retinitis (6 patients).

Discussion

Our study found sexual route as the most common mode of transmission of HIV seen in 66.5% of patients. Study by Mukta S et al. showed that heterosexual transmission was most common mode of transmission in 84%. Our study showed the prevalence of ocular manifestations among HIV positive patients as 39%. Sujani Bairy showed that 56.8% had ocular manifestations. Shivayogi K et al. conducted showed that 46%. In our study, the majority of HIV infected patients with CD4 count less than 100 has ocular manifestations i.e., 14 patients (87.5%) out of 16 with CD4+ T cell counts < 50 cells /ml and 32 patients (80%) out of 40 with CD4 count between 51-100.

In the present study, adnexa of eyes involved in total 31 patients of HIV/ AIDS (7.75%). Anterior segment manifestations were more common compared to posterior segment manifestations in HIV / AIDS patients. The most common ocular manifestation of posterior segment in HIV patients in our series was HIV retinopathy (18 patients) followed by CMV retinitis (6 patients). Orbital and neuro- ophthalmologic complications of HIV/AIDS were seen in 11 patients out of 156 patients with ocular involvement (7.05%).

Conclusion

The study concluded that HIV/Aids is a significant cause of ocular disease. Almost around 39% patients having HIV/AIDS have eye disease. Usually, early presentation of ocular manifestations in HIV/AIDS patients is asymptomatic or with very less and unnoticed symptoms, which further leads to delay in diagnosis and treatment leading to major disease occurrence.

Thus, regular screening of positive patients and comprehensive ophthalmic examination will help in identifying ocular morbidity earlier.

Ethical Consideration

Complete confidentiality of data was maintained throughout the research. It was the sole responsibility of principal investigator. We started the research only after written permission from the IEC.

Source of Funding

No funding and expenses.

Conflict of Interest

No conflict of interest.