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/microL. 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 Fairfield 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 microL 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.

Low frequency maintenance ganciclovir for cytomegalovirus retinitis.

45 patients on maintenance ganciclovir for treated cytomegalovirus (CMV) retinitis were reviewed retrospectively. Treatment was given at 30 mg/kg/week in 3 divided doses: Monday, Wednesday, Friday. The median time to clinical relapse was 5.4 months. This is similar to that reported with higher frequency maintenance regimens. The high degree of immunodeficiency (median CD4 count 16 cells/microliters) and poor prognosis (median survival 8.2 months) associated with CMV retinitis were confirmed.

Cytomegalovirus cultures during maintenance DHPG therapy for cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS).

Nine patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis on maintenance therapy with ganciclovir: 9(1,3-dihydroxy-2-propoxymethyl) guanine (DHPG) at high dose (30 mg/kg/week) or low dose (20 mg/kg/week) were tested every 1-2 weeks for CMV isolation from blood, saliva, and urine. Duration of therapy ranged from 1.5 to 12 months (average 5.3 months). During pretreatment and low-dose and high-dose maintenance therapy, CMV was isolated from 48/59 (81%), 90/211 (43%), and 40/290 (14%) of specimens, respectively. Three patients with progressive retinitis had viraemia more frequently than did six patients with stable retinitis, CMV being isolated from 29/47 (62%) and 17/121 (14%) of blood samples, respectively.

Primary dapsone chemoprophylaxis for Pneumocystis carinii pneumonia in immunocompromised patients infected with the human immunodeficiency virus.

During a 12-month period from August 1, 1986 to July 31, 1987, a study of primary chemoprophylaxis with dapsone for Pneumocystis carinii pneumonia was undertaken in immunodeficient patients who were infected with the human immunodeficiency virus. One attack of P. carinii pneumonia occurred among 16 patients who received chemoprophylaxis immediately that a T-helper (CD4) lymphocyte count of less than 0.2 x 10(9)/L was recorded compared with 16 attacks in the historical control group of 46 similar patients who did not receive chemoprophylaxis (log-rank test, chi 2(1) = 3.72; P = 0.05).

Ruptured abdominal aortic aneurysm: a complication of Salmonella bovis-morbificans infection.

A clinical report is presented of a patient who developed Salmonella bovis-morbificans infection and ruptured an abdominal aortic aneurysm as a complication. The management is discussed and treatment suggested.