Ocular manifestations in patients with AIDS

AIDS is an infectious disease caused by the human immunodeficiency virus (HIV) and is considered one of the most devastating public health problems in recent history. It was first recognized in the United States in 1981 and the number of patients afflicted by it has been growing year by year (34 million patients affected actually). It has spread to all five continents with a significant number infected in the Caribbean of which St. Vincent and the Grenadines is of no exception.

Infection by HIV can be acquired directly via the blood stream (transfusions, cuts and needles), through sexual relationship(s) or transmitted from mother to child during pregnancy or breast-feeding.{{more}}

Upon attaining the virus, several years could pass by without the individual presenting any obvious manifestations (asymptomatic carrier) BUT he/she could transmit the virus to other persons. Once the patient starts presenting the clinical signs related to this disease we can say that the patient has AIDS. The immunological (defense) system along with the gastro-intestinal tract are the first to be affected but all the other tissues of the organism in one way or the other will be involved. Infections of various sorts start appearing and if there is cancer it will be very aggressive in these patients; however with the treatments available nowadays survival of these patients has increased which is why we have to be prepared to recognize and treat the ocular modifications that might appear in these patients.

The organ responsible for our vision (our eyes) can be damaged with compromise of the anterior chamber as well as the posterior one and also its annexes (eyelid, eyelashes, lagrimal system) and even occasionally resulting in blindness. However, without doubt the most frequent ocular manifestation is the non-infectious AIDS retinopathy (damage in the retina- posterior part of the eye) present in about 70% of cases infected. This is characterized by cotton-wooly exudates and retinal hemorrhage; retinitis (retinal inflammation) caused by cytomegalovirus (CMV), ophthalmologic herpes zoster of the eyelid and cornea, keratitis (inflammation of the cornea) corneal ulcers, uveitis, retinitis caused by toxoplasmosis, Candida and tuberculosis, Kaposi’s sarcoma, infections with herpes simple and zoster and finally blindness.

HIV is not transmitted by handshakes or other non-sexual contact, by coughing or sneezing or by bloodsucking insects such as mosquitoes. My fellow reader, do not forget that AIDS HAS NO FACE; therefore I encourage you to always have a safe sexual relationship.

Dr. Pedro A. Ferrer Suarez

Consultant Ophthalmologist MCMH