436. Ocular Disease in Hospitalized Adults with HIV Infection
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1
Background:   Prior to the introduction of highly active antiretroviral therapy (HAART), complications of the eye, especially opportunistic infections (OIs), affected a significant number of patients with HIV infection. Since the introduction of HAART, both mortality and the incidence of OIs among AIDS patients have decreased.  Eye disease in HIV-infected patients, however, remains an important consideration. There are many infectious and non-infectious diseases that can affect the eye and occur at varying stages in the course of HIV infection.

Methods: Retrospective chart review of HIV-infected adults with active ocular disease admitted to the Wills Eye Institute and Thomas Jefferson University Hospitals between December 30, 1995 and October 31, 2010.

Results: Two hundred and fifty-three active ocular diagnoses were identified in 222 admissions for 188 patients. Median age of patients at diagnosis was 42 (19-79).  Median CD4 cell count was 82 cells/uL (0-1266).  One hundred and thirty-four (60%) cases occurred in patients on ART. Among 159 exams for which it was documented, visual acuity was <20/40 for 25 (15.7%), and <20/100 for 90 (56.6%). There was a predominance of non-infectious diagnoses 146 (57.7%); the most frequent were non-infectious retinopathy 36 (14.2%), retinal detachment 16 (6.3%), cataract 7 (2.8%), glaucoma 6 (2.4%), non-infectious uveitis 6 (2.4%), cranial nerve palsy 6 (2.4%), and trauma 5 (2%). For infectious diagnoses, CMV retinitis 35 (13.8%), necrotizing herpetic retinitis 13 (5.1%), non-ulcerative keratitis 11 (4.3%), preseptal cellulitis 9 (3.6%), ocular syphilis 7 (2.8%), herpes zoster ophthalmicus 6 (2.4%) and endogenous endophthalmitis 5 (2%) were the most common.

Conclusion: While HIV-related eye disease typically focuses on infectious diagnoses, this study reports a predominance of non-infectious diseases affecting the eye in HIV-infected hospitalized adults.   As HIV patients are living longer with access to HAART, non-infectious eye diagnoses may be encountered more frequently.  Both infectious and non-infectious eye disease can be associated with significant morbidity. These findings underscore the need for vigilant eye care as part of the comprehensive management of patients living with HIV. 


Subject Category: H. HIV/AIDS and other retroviruses

Lorena Perez-Povis, MD1, Josephine Lontok, MD1, William Short, MD, MPH2, Randi Silibovsky, MD2, Christopher Fecarotta, MD3, Christopher Miller, MD4, Cassandra Thomas, MD4 and Katherine Belden, MD2, (1)Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, (2)Infectious Diseases, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, (3)Ophthalmology, Wills Eye Institute/Thomas Jefferson University, Philadelphia, PA, (4)Internal Medicine, Thomas Jefferson University, Philadelphia, PA

Disclosures:

L. Perez-Povis, None

J. Lontok, None

W. Short, None

R. Silibovsky, None

C. Fecarotta, None

C. Miller, None

C. Thomas, None

K. Belden, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.