A prevalence study of ocular manifestations in HIV positive patients on highly active anti-retroviral therapy

Background: Among 40 million cases worldwide, 50-75% of patients have at least one ocular manifestation in their lifetime. Many of ocular infections are treatable with therapeutic agents. Ocular manifestations invariably reflect systemic disease and can be the initial manifestations of HIV in many cases. Understanding of ocular sequel of HIV infection can lead to the early diagnosis and effective treatment. This study emphasizes on the need of developing a specific ophthalmic examination for the management of ocular manifestations in HIV infected patients.Methods: Cross sectional and observational study of 100 HIV positive participants on HAART were done irrespective of presence or absence of ocular symptoms. Participants were examined for complete ocular examination. Prevalence find out using chi-square test, find p values and ensuring statistical significance.Results: In our study, prevalence of ocular manifestation in HIV positive patients receiving HAART was 39%. Out of them, 20% adnexal involvement, 28% anterior segment involvement, 33% posterior segment involvement, 11% neuro-ophthalmic abnormality, 4% orbital involvement were present. 76% patients belonged to WHO clinical stage 2 and 3. 51% had CD4+ T cell counts <200 cells/µl.Conclusions: Posterior segment followed by anterior segment are the most commonly encountered ocular manifestations of HIV infection. Low CD4 count is good predictor for ocular manifestations in HIV positive patients. Higher WHO stage is also directly related with the severity of the ocular symptoms. Routine baseline ophthalmic screening to all HIV positive patients are necessary to prevent ocular morbidity.

A study of mode of transmission, clinical presentations, WHO and immunological staging among HIV infected children.

Background: The clinical manifestations of HIV infection vary widely among infants, children, and adolescent. So there is a need to study the mode of transmission, clinical presentations, WHO and immunological staging among HIV infected children. Methods: Observational analytic cross sectional study. The children who were HIV positive (confirmed by ELISA for HIV-1 and HIV-2), and attending the OPD of ART Centre and SN Children Hospital, Allahabad during period of one year. The study population consisted of 47 patients, belonging to both sexes and age of 18 months to 19 years. Detailed history was taken and full clinical examination done in all cases. CD4 count was estimated at the time of presentation. Results: Predominant mode of transmission in our study was vertical and it was present in 95% cases. Fever was the most common presenting complaint and was present in 28 (59.57%) cases. The most common clinical sign was pallor in our study, present in 37 cases (78.72%) followed by lymphadenopathy 34 (72.34%). On the basis of WHO clinical staging, most of the patients in our study were found in stage 2 .On the basis of immunological staging, 51% had no evidence of immunosuppression (stage1), 18 (38.3%) had mild to advanced immunosuppression (stage 2 and 3) and 5 (10.63%) patients were severely immunosuppressed (stage 4). Conclusion: In HIV infected children predominant mode of transmission is vertical. Fever and pallor are common clinical manifestations. Most of the patients are found in WHO clinical stage 2 and immunological stage 1.