PMID- 19775470
OWN - NLM
STAT- MEDLINE
DCOM- 20091103
LR  - 20211020
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 9
DP  - 2009 Sep 23
TI  - Prevalence of HIV-associated ophthalmic disease among patients enrolling for 
      antiretroviral treatment in India: a cross-sectional study.
PG  - 158
LID - 10.1186/1471-2334-9-158 [doi]
AB  - BACKGROUND: The ocular manifestations of HIV may lead to visual impairment or 
      blindness. In India, patients typically initiate antiretroviral treatment (ART) 
      with low CD4 cell counts when the risk of ocular complications may be high. The 
      objective of this study was to determine the prevalence and types of 
      HIV-associated ocular conditions in patients referred for ART in India. METHODS: 
      This cross-sectional study was undertaken at a large public sector ART centre in 
      Mumbai, India. Data collection including a standardised symptom screen, and an 
      ophthalmic examination were performed on all consecutive patients satisfying the 
      criteria for enrollment into the ART clinic irrespective of the presence or 
      absence of ophthalmic/visual symptoms. RESULTS: Enrolled patients (n = 149) had a 
      median CD4 cell count of 180 cell/microL (inter-quartile range [IQR], 106-253 
      cells/microL). The prevalence of HIV-associated ocular disease was 17.5% (95% CI, 
      11.2-23.6%) in all participants and 23.8% (95% CI: 14.5-33.1) in those with CD4 
      cell counts <200 cells/microL (n = 84). Only 7.7% of patients with HIV-associated 
      ocular disease reported any eye symptoms in the standardised symptom screen. 
      Objective visual impairment was detected in 20% of those with HIV-associated 
      ocular disease compared to 6% in those without ocular manifestations (p = 0.02). 
      Vitreoretinal disease was the most common manifestation, of which cytomegalovirus 
      retinitis (CMVR) was the most frequent retinal infection (overall prevalence 
      8.7%, 95% CI: 4.1-13.3%). In a multivariable analysis, HIV-associated ocular 
      disease was independently associated with a CD4 count <100 cells/microL (odds 
      ratio [OR], 6.3, 95% CI: 1.5-25.9) and WHO clinical stages 3 and 4 (OR 9.4, 95% 
      CI: 2.4-37.2). However, symptoms were not independently predictive of ocular 
      disease. Sensitivity of ocular symptom screening was 7.7%, with a positive 
      predictive value of 18% in this population. CONCLUSION: Over a fifth of 
      unselected patients who are eligible for ART in this setting have HIV-related 
      ocular disease of which CMVR is the most common form. Such patients may be at 
      risk of developing ocular immune reconstitution phenomena during ART. Screening 
      for ocular symptoms is not a reliable method to identify those with ocular 
      morbidity and this highlights the need for routine ophthalmic screening prior to 
      commencement of ART.
FAU - Pathai, Sophia
AU  - Pathai S
AD  - International Centre for Eye Health, London School of Hygiene & Tropical 
      Medicine, London, UK. sophia.pathai@gmail.com
FAU - Deshpande, Alaka
AU  - Deshpande A
FAU - Gilbert, Clare
AU  - Gilbert C
FAU - Lawn, Stephen D
AU  - Lawn SD
LA  - eng
GR  - Wellcome Trust/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20090923
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Anti-Retroviral Agents/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Cross-Sectional Studies
MH  - Eye Diseases/*complications/epidemiology/virology
MH  - Female
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - India/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prevalence
MH  - Risk Factors
MH  - Sensitivity and Specificity
MH  - Young Adult
PMC - PMC2759932
EDAT- 2009/09/25 06:00
MHDA- 2009/11/05 06:00
PMCR- 2009/09/23
CRDT- 2009/09/25 06:00
PHST- 2009/06/03 00:00 [received]
PHST- 2009/09/23 00:00 [accepted]
PHST- 2009/09/25 06:00 [entrez]
PHST- 2009/09/25 06:00 [pubmed]
PHST- 2009/11/05 06:00 [medline]
PHST- 2009/09/23 00:00 [pmc-release]
AID - 1471-2334-9-158 [pii]
AID - 10.1186/1471-2334-9-158 [doi]
PST - epublish
SO  - BMC Infect Dis. 2009 Sep 23;9:158. doi: 10.1186/1471-2334-9-158.