Ophthalmic manifestations in HIV positive patients: Evaluation of 286 consecutive patients in one year

Purpose:To evaluate the frequency of ophthalmic manifestations in HIV positive patients seen in a referral eye clinic in Northern Italy during one year. Methods: In this retrospective study we reviewed the charts of 286 HIV positive patients consecutively seen in the Ophthalmology Service, of the Infectious Diseases Clinic (San Raffaele Hospital Milan, Italy) from March 2003 to March 2004. In the Infectious Disease Clinic 3500 HIV positive patients are followed every year. Results: The total number of patients who underwent complete ocular examination during one year period was 286 (8.2% of all HIV positive patients referred to the Infectious Disease Clinic); 200 patients were males (69.9%), and 86 woman (30.1%) with a median age at visit presentation of 44 years (range: 27–67years). The total number of ophthalmologic examinations performed during 1 year was 418; 74.1% of patients underwent one visit, 18.2% two visits and 7.7% more than 2 visits per year. In the latter group the most frequent ocular diseases for referral consult were infectious retinitis and herpetic keratouveitis. Anterior segment diseases were found in 52 patients (18.2%): ocular surface disorders (28.9%), conjunctivitis (23%), herpetic keratouveitis (13%), and anterior uveitis (7.7%). Posterior segment diseases were found in 56 patients (19.5%): Cytomegalovirus retinitis (44.6%), HIV microangiopathy (12.5%), diabetic retinopathy (8.9%), maculopathy (5.3%), other infectious retinitis (Candida, Toxoplasmosis, Syphilis, Tuberculosis) (12.2%), and acute retinal necrosis (1.7%). Immune recovery uveitis was found in 1.7% of patients. In 178 (62.3%) patients referred for consult the ophthalmologic examination showed no evidence of disease other than refractive errors. Conclusions: In this study 62.3% patients did not show any evidence of ocular disease. The most frequent anterior segment diseases were ocular surface disorders and conjunctivitis (51.9%). The most frequent posterior segment disease was Cytomegalovirus retinitis (44.6%). The introduction of highly active antiretroviral therapy has modified the incidence of ocular manifestations in HIV positive patients but CMV retinitis remains the major vision–threatening problem.