Ocular manifestations of infection with the human immunodeficiency virus in an African pediatric population

Purpose: To describe the ocular manifestations of HIV/AIDS infection in an African pediatric population. Methods: From 1984 to 1990, all children with HIV infection attending the Department of Pediatrics of the 'Centre Hospitalier de Kigali', Rwanda, were referred to the Department of Ophthalmology for ophthalmic examination. Results: A total of 162 HIV-infected children were examined. The overall rate of ophthalmic involvement was 54%. The most common finding was a perivasculitis of the peripheral retinal vessels, observed in 38% of the patients. Cytomegalovirus (CMV) infection of the retina was diagnosed in three patients. Isolated cotton-wool spots of the retina were not observed. Ophthalmic herpes zoster and conjunctival xerosis responding to vitamin A administration were each seen in two patients. One third of a subset of children tested for lacrimal function had evidence of decreased tear secretion. Conclusion: Our data, in agreement with other series reported in the literature, indicate that cotton-wool spots and CMV retinitis, the most common ocular manifestations of HIV/AIDS in adults, are much less prevalent in children. The high incidence of perivasculitis in the present series, not observed or only seen in a few cases in other series, suggests that this ocular sign is more prevalent in African children. Our working hypothesis is that perivasculitis of the retinal vessels, lymphoid interstitial pneumonitis, parotitis, and lacrimal gland involvement are the expression of a diffuse infiltrative lymphocytosis syndrome, similar to what has been described in adults.