Ophthalmic Manifestations in Human Immunodeficiency Virus Patients at Presentation in a Tertiary Care Hospital

Background: Numerous ophthalmic manifestations of human immunodeficiency virus (HIV) infection may involve the anterior or posterior segment of the eye. Anterior segment findings include a variety of external infections and tumors of the periocular tissues. Posterior segment changes include an HIV-associated retinopathy and a number of opportunistic infections of the retina and choroid. Materials and Methods: Observational cross-sectional study done over a period of 6-month at a Tertiary Care Hospital. A total of 246 HIV positive patients were screened for ophthalmic manifestations. CD4 counts correlated with anterior and posterior segment lesions. Patients already on treatment for eye manifestations were excluded. Results: Out of the 246 patients, 127 (51.62%) were in the 4th decade of life. About 28 patients (88.60%) had ophthalmic manifestations out of the total 246 patients. Visual acuity was better or equal to 6/12 in 42.85% of patients (12). Posterior segment lesions were found in 18 patients (64.3%), anterior segment lesions in 7 (25%), and both anterior and posterior segment lesions in 3 patients (10.7%). About 50% of patients had CD4 count >500/cumm, ophthalmic manifestations were present at all CD4 counts. 6 patients with anterior segment lesions had CD4 count >200 with only 1 patient having <200. Of the 21 patients with posterior segment findings, 18 had CD4 count <500. All 3 patients with anterior and posterior segment findings had CD4 count <100. HIV retinopathy was present in all ranges of CD4 count. 3 patients with cytomegalovirus (CMV) retinitis had CD4 count <200. Opportunistic infections were predominant in CD4 count in the range of 200. Conclusion: HIV retinopathy, CMV retinitis, blepharitis, anterior uveitis, and viral keratitis are the ophthalmic manifestations at presentation in order of prevalence in this study. Low CD4 count is a good predictor for CMV retinitis and posterior segment manifestations in patients with anterior segment lesions.