Basic and Clinical Research Related to Ocular Complications in Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome Patients

  Objective  To review the clinical features, treatment effectiveness, and aqueous humor and tear virus load results of the ocular complications in human immunodeficiency virus infection/acquired immuno-deficiency syndrome (HIV/AIDS) patients diagnosed and treated in Department of Ophthalmology in Peking Union Medical College Hospital.

  Methods  We retrospectively reviewed the clinical features and treatment effectiveness of ocular complications in 223 HIV/AIDS patients in the period from January 2001 to December 2015, including 157 males and 66 females. The mean age was (39.2±9.7) (8.0-78.0) years. Their HIV exposure, clinical manifestations of ocular complications, diagnostic examinations, and treatment were reviewed.

  Results  Ocular manifestations were found in 99 (44.4%, 156 eyes) of the 223 patients, including cytomegalovirus retinitis (CMVR) in 64 eyes (40 patients), HIV retinopathy in 54 eyes (35 patients), HIV and syphilis double infection with fundus disease in 20 eyes (13 patients), immune reconstitution inflammatory syndrome (IRIS) in 16 eyes (10 patients), and chronic dacryoadenitis in 2 eyes (1 patient). Tear secretion was lower in HIV/AIDS patients with CD4⁺T cell less than 50/mm³ than in normal people (P=0.008). HIV-1 virus was found in the aqueous humor and tears of 16 HIV/AIDS patients responding to highly active antiretroviral therapy (HAART) and with undetectable plasma viral load, with the median viral load being 2291 (519, 6667) copies/ml.

  Conclusions  CMVR is the most common opportunistic infection among the ocular complications of late-stage HIV/AIDS patients. Early diagnosis and systematic/topical treatment may save the vision of most patients. Detectable viral load may still be present in aqueous humor and tears even in patients with undetectable viral load in the blood, suggesting that precautions should be taken to prevent transmission of HIV virus.