AIDS and the eye A 10-year experience

Background: The AIDS database at Fairfield Hospital, Melbourne, maintains information on eye pathology as identified by the three visiting ophthalmologists. Patients underwent an eye consultation: if they had ocular symptoms; if signs were seen on direct ophthalmoscopy by physicians; or when their CD₄+ve cell count fell below 50/μL. The first AIDS-associated eye signs were identified in mid-1984. In the subsequent decade, 3257 patients in Victoria tested positive for HIV, and 845 of the 1123 who developed AIDS were treated at Fairfield Hospital. Methods: We undertook a retrospective review of the Fail-field Hospital database to identify the AIDS-associated ocular problems seen. Results: Some 723 patients had an eye consultation. In the earliest stage of HIV infection, minor non-specific ophthalmic involvement may occur. As the disease progresses, microvasculopathy (cottonwool spots and haemorrhages) appears. External disease also occurs such as molluscum contagiosum and Kaposi's sarcoma of the conjunctiva. With more suppression of the immune system, opportunistic infections become common, and have a considerable visual morbidity. Cerebral toxoplasmosis (117 patients) is only rarely associated with ocular involvement (three patients), but cytomegalovirus (CMV) commonly causes retinitis [204 patients (24%)]. It has been the AIDS-defining illness in 26 patients. A majority had the disease confined to one eye. Mean CD₄ cell count at onset is 15±5 μL and it has been associated with a viraemia in all but two patients. Late complications of CMV retinitis include relapse in 41 (20%), spread to the other eye in 24 (12%), and retinal detachment in 30 (15%). Visual impairment follows from retinal destruction, optic nerve involvement, and retinal detachment. Conclusion: The ophthalmic workload from late ocular complications of AIDS is increasing. Newer and more-effective methods of treatment are being developed. Ophthalmologists are becoming more aware of the need for universal precautions to avoid risks from this and other blood-borne infections.