Acquired Immune Deficiency Syndrome AIDS

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Acquired immune deficiency syndrome (AIDS) refers to the final stages of infection by the human immunodeficiency virus (HIV). The earlier stages of the disease are often asymptomatic (Table 21.4).

In western countries, AIDS commonly affects homosexuals, haemophiliacs, and intravenous drug abusers, although there is now a significant heterosexual and paediatric pool of patients. In Africa, it is generally a heterosexual disease, and a significant paediatric population is also known. Transmission is through sexual intercourse, parenteral or transplacental routes.

Ocular features occur in 75% of patients with AIDS. The major ocular complications of AIDS occur later in the disease and can be predicted by CD4 T-cell levels. At CD4 level >200 x 106/L common ocular complications are toxoplas-mosis and herpes zoster ophthalmicus and retinitis, while at CD4 levels <50 x 106/L cytomegalovirus (CMV) retinitis is common.

AIDS microangiopathy (noninfectious) occurs in about 50% of patients (in both developing and western countries). It consists of microa-neurysms, telangiectasia, cotton-wool spots and a few retinal haemorrhages. Retinal peripheral perivascular sheathing may sometimes occur in the absence of intraocular infections.

Other ocular involvement of AIDS includes infections with opportunistic and

Table 21.4. Classification of human immunodeficiency virus (HIV) infection (Centers for Disease Control, Atlanta, 1992).

Group I

Acute infection: asymptomatic with

seroconversion

Group II

Asymptomatic carrier

Group III

Generalised,persistent

lymphadenopathies; usually good

state of general health

Group IV

AIDS

Sub-

(A) Constitutional (cachexia, fever, etc.).

groups

(B) Neurological.

(C) Infections diagnostic of AIDS.

(D) Malignancies.

(E) Others, e.g. CD4 count <200 x 106/L.

Figure 21.15. Cytomegalovirus retinitis in acquired immune deficiency syndrome (AIDS).EQ

Figure 21.15. Cytomegalovirus retinitis in acquired immune deficiency syndrome (AIDS).EQ

nonopportunistic organisms (e.g., CMV, crypto-coccus and molluscum contagiosum) (Figures 21.15 and 21.16). Neoplasms of the conjunctiva, lids and orbit, and neurophthalmic complications are other features.

In western countries,the commonest ophthalmic complication of AIDS is CMV retinitis, while in developing countries (such as Africa), CMV is not a major problem. Herpes zoster ophthalmicus and conjunctival carcinoma are common in AIDS patients in Africa and AIDS patients die of other complications, for example tuberculosis. Therefore, short-term survival from AIDS itself is a problem in developing countries, while in western countries quality of life for the longer term is the main problem.

Treatment with the highly active antiretro-viral therapy (HAART) regimen leads to signi-

Figure 21.16. Human immunodeficiency virus retinopathy.!

ficant elevation of CD4 T-cell levels such that the ocular complications, especially opportunistic infections, are less commonly encountered.

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