Comparison and correlation of ophthalmic and systemic manifestations with respect to CD4 counts in HIV infected adults
Abstract
Purpose: To compare and correlate ophthalmic and systemic manifestations with respect to CD4 counts in HIV infected adults.
Materials and Methods: In a prospective clinical study, 182 HIV positive patients were evaluated for their ophthalmic findings. All patients underwent complete ophthalmic examination including detailed history, best corrected visual acuity, slit lamp examination, indirect ophthalmoloscopy and +90D lens biomicroscopy. Fundus photographs were taken in patients with ocular manifestations. Routine blood tests including total and differential count, Hb levels, erythrocyte sedimentation rate, erythrocyte and platelet counts were done. Serologic tests (ELISA for IgM antibody) for toxoplasma, cytomegalovirus was done in clinically suspicious cases. VDRL, and chest x-ray was performed in cases suspected to have syphilis and tuberculosis respectively.
Results: 182 patients were examined, 65.9% male and 34.1% being female patients. Most common systemic manifestation was pulmonary TB (39.1%) (p <0.001), second common being oral candidiasis (16.5%) (p <0.001) followed by abdominal TB (15.5%). Also, 37.9% patients had ocular lesions out of which 15.4% had HIV retinopathy, second common was CMV retinitis(9.3%) followed by HIV optic neuropathy(3.8%). 34.1% had CD4<100, 44% between 01-100 and 22% had CD4 >200. . Twenty five % of patients with pulmonary TB had HIV retinopathy and 12% with pulmonary TB had CMV retinitis. Among the 30 oral candidiasis patients 8(26.6%) developed HIV retinopathy, where as 10% developed CMV retinitis. Fifty seven % of patients with HIV retinopathy had CD4<100, 28.6% with CD4 between 101-200 and 14.3% with CD4 >200. Similarly 47.1% with CMV retinitis had CD4 <100, 52.9% had CD4 101-200. None with CD4 >200 developed CMV retinitis.
Conclusions: Study shows an increased prevalence of systemic diseases along with ocular diseases with decreased CD4 counts, particularly <100. Pulmonary TB is seen more frequently with CD4<200 and is also seen to be associated increasingly with ocular manifestations and more so when CD4 <100.
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References
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