Ocular Manifestations in HIV Positive and AIDS Patients in Nepal

Background: HIV has the capability to affect every organ system in the body. Ocular manifestations have been reported in up to 70% of individuals infected with HIV and the ocular manifestations reflect systemic disease and may be the first sign of disseminated infection. Aim: To identify different types of ocular involvement in the cases known to be infected with HIV. Methods: A cross sectional, descriptive study was undertaken during the period between January 2005 and July 2006. All the diagnosed cases of HIV infected individuals either coming to the hospital or collected from rehabilitation centres were included in the study. Results: 103 HIV infected cases were examined; of which 45 cases (43.6%) were AIDS cases. The mean age of presentation was 29.6 ± 9.8 years. The commonest systemic disease was pulmonary tuberculosis (65.9%). In the study group, 38.8% of the cases had ocular involvement. In the ocular findings, posterior segment lesions (32%) were most common. Ocular involvement among asymptomatic patient was 22.7% while it was 91.6% among symptomatic patients. HIV retinopathy (23.3%) was the most common HIV-associated ophthalmic lesions. Ocular involvement was the most common in cases that contracted the disease through sexual contact. A negative correlation was observed between CD4 level and ocular involvement. Conclusion: There needs to be awareness of ocular involvement among HIV infected individuals and an increased emphasis on regular ophthalmic examination in all HIV patients. Routine referral system for ocular evaluation from other medical departments seems mandatory for timely diagnosis of the vision threatening conditions.