Ocular Manifestations in HIV Positive and AIDS Patients in Nepal


Background: HIV has the capability to affect every organ system in the body. Ocular manifestations have been reported in up to 70% of individuals infected with HIV and the ocular manifestations reflect systemic disease and may be the first sign of disseminated infection. Aim: To identify different types of ocular involvement in the cases known to be infected with HIV. Methods: A cross sectional, descriptive study was undertaken during the period between January 2005 and July 2006. All the diagnosed cases of HIV infected individuals either coming to the hospital or collected from rehabilitation centres were included in the study. Results: 103 HIV infected cases were examined; of which 45 cases (43.6%) were AIDS cases. The mean age of presentation was 29.6 ± 9.8 years. The commonest systemic disease was pulmonary tuberculosis (65.9%). In the study group, 38.8% of the cases had ocular involvement. In the ocular findings, posterior segment lesions (32%) were most common. Ocular involvement among asymptomatic patient was 22.7% while it was 91.6% among symptomatic patients. HIV retinopathy (23.3%) was the most common HIV-associated ophthalmic lesions. Ocular involvement was the most common in cases that contracted the disease through sexual contact. A negative correlation was observed between CD4 level and ocular involvement. Conclusion: There needs to be awareness of ocular involvement among HIV infected individuals and an increased emphasis on regular ophthalmic examination in all HIV patients. Routine referral system for ocular evaluation from other medical departments seems mandatory for timely diagnosis of the vision threatening conditions.

Share and Cite:

J. Purushottam, A. Thakur, M. Choudhary, S. Sharma and D. Shah, "Ocular Manifestations in HIV Positive and AIDS Patients in Nepal," International Journal of Clinical Medicine, Vol. 3 No. 1, 2012, pp. 14-21. doi: 10.4236/ijcm.2012.31003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] R. A. Weiss, “How Does HIV Cause AIDS?” Science, Vol. 260, No. 5112, 1993, pp. 1273-1279. doi:10.1126/science.8493571
[2] D. C. Douek, M. Roederer and R. A. Koup, “Emerging Concepts in the Immunopathogenesis of AIDS,” Annual Reviews, Vol. 60, No. 1, 2009, pp. 471-484. doi:10.1146/annurev.med.60.041807.123549
[3] CDC, “1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS among Adolescents and Adults,” MMWR, No. RR-17, 1992, p. 41.
[4] UNAIDS and WHO, “AIDS Epidemic Update,” Joint United Nations Programme on HIV/AIDS and World Health Organization, Geneva, 2009.
[5] UNGASS, “Country Progress Report,” 2008.
[6] UNAIDS, “Joint United Nations Programme on HIV/AIDS (UNAIDS),” 2006 Report on the Global AIDS Epidemic, Geneva, 2006
[7] American Academy of Ophthalmology, “Intraocular Inflammation and Uveitis Section 9. Basic and Clinical Science Course, 2001-2002,” San Francisco, 2001, pp. 216- 237
[8] D. A. Jabs, “Ocular Manifestations of HIV Infection,” Transactions on the American Ophthalmological Society, Vol. 93, 1995, pp. 623-683
[9] D. A. Jabs, J. T. Holbrook, M. L. Van Natta, R. Clark, M. A. Jacobson and R. L. Murphy, “Risk Factors for Mortality in Patients with AIDS in the Era of Highly Active Antiretroviral Therapy,” Ophthalmology, Vol. 112, No. 5, 2005, pp. 771-779
[10] I. Pecorrella, A. Ciardi, A. Garner, A. C. E. McCartney and S. lucas, “Postmortem Histological Survey of the Ocular Lesion in a Brirish Population of AIDS Patients,” British Journal of Ophthalmology, Vol. 84, No. 11, 2000, pp. 1275-1281. doi:10.1136/bjo.84.11.1275
[11] M. C. Lim, W. G. Cumberland, S. L. minassin, S. S. Ransome, M. J. Cornish, B. G. Terry and G. N. Holland, “Decreased Macular leukocute Velocity in Human Immunodeficiency Virus-Infected Individuals,” American Journal of Ophthalmology, Vol. 132, No. 5, 2001, pp. 711-719.
[12] R. Belfort and C. Muccioli, “Experience of HIV/AIDS and the Eye in Brazil, South America,” Community Eye Health, Vol. 8, 1995, pp. 26-27.
[13] A. C. Wadood, B. Dhillon, G. McIlwaine and R. P. Brettle, “Delayed Diagnosis of HIV Infection in Ophthalmic Practice,” Eye, Vol. 18, 2004, pp. 293-298. doi:10.1038/sj.eye.6700630
[14] K. G. A. Eong, S. Beatty and S. J. Charles, “Cytomegalovirus in Patients with Acquired Immune Deficiency Syndrome,” Post-graduate Medical Journal, Vol. 75, 1999, pp. 585-590.
[15] P. A. Sample, D. J. Plummer, A. J. Mueller, K. I. Mastsubara, A. Sadun, I. Grant and W. R. Freeman, “Pattern of Early Visual Field Loss in HIV-Infected Patients,” Archives of Ophthalmology, Vol. 117, No. 6, 1999, pp. 755-760
[16] J. Biswas, H. N. Madhwan, A. E. George, N. Kumarasamy and S. Solomon, “Ocular Lesion Associated with HIV Infection India: A Series of 100 Consecutive Patients Evaluated at Referral Center,” American Journal of Ophthalmology, Vol. 129, No. 1, 2000, pp. 9-15. doi:10.1016/S0002-9394(99)00415-8
[17] D. F. Rofsberger, M. H. Heineman, D. D. N. Friedberg and G. N. Holland, “Uveitis Associated with Human Immunodeficiency Virus Infection in India. American Journal of Ophthalmology, Vol. 125, No. 3, 1998, pp. 301-305
[18] J. Tanterdam, S. Suwannagool, C. Namatra and A. Singalavaniza, “A Study of Ocular Manifestations in HIV Patients,” Thai Journal of Ophthalmology, Vol. 10, No. 1, 1996, pp. 11-20.
[19] I. Cocherau, N. Milka-Cabanne, P. Godinaud, T. Niyangabo and B. Larouzea, “AIDS Related Eye Disease in Burundi, Africa,” British Journal of Ophthalmology, Vol. 83, No. 3, 1998, pp. 374-382.
[20] R. B Nussenblatt and H. C. Lane, “Human Immunodeficiency Virus Disease: Changing Pattern of Intraocular Inflammation,” American Journal of Ophthalmology, Vol. 129, No. 3, 1998, pp. 373-382
[21] P. G. Kestelyn1 and E. T. Cunningham Jr., “HIV/AIDS and Blindness,” Bulletin of the World Health Organization, Vol. 79, No. 3, 2001, pp. 208-213.
[22] World Health Organization, “Interim Who Clinical Staging of HIV/AIDS Case Definitions for Surveillance,” WHO, 2005. http://www.who.int/hiv/pub/guidelines/clinicalstaging.pdf
[23] UNAIDS, “Joint United Nations Programme on HIV/AIDS,” Report on the Global AIDS Epidemic, Geneva, 2006. http://www.unaids.org/en/hiv_data/2006globalreport/default.asp
[24] D. A. Jabs, “AIDS and Ophthalmology in 2004,” Archives of Ophthalmology, Vol. 122, No. 7, 2004, pp. 1040-1042. doi:10.1001/archopht.122.7.1040
[25] E. T. Cunningham Jr. and T. P. Margolis, “Ocular Manifestations of HIV Infection,” New England Journal of Medicine, Vol. 339, 1998, pp. 236-244. doi:10.1056/NEJM199807233390406
[26] K. S. Sriprakash, R. Babu, C. Kumar, et al., “Ocular Manifestations of HIV/AIDS. An Experience at Major Eye Hospital in South India,” 62nd Conference on All India Ophthalmologic Society, Varanasi, 8-11 January 2004.
[27] H. R. Awan and H. S. Adala, “Ophthalmic Manifestations of Acquired Immunodeficiency Syndrome in Kenya,” Ophthalmic Practice (Asian Edition), Vol. 1, 1996, pp. 92-102
[28] N. A. V. Beare, J. G. Kublin, D. K. Lewis, M. J. Schiffelen, R. P. H. Peters, G. Joaki, J. Kumwenda and E. E. Zijlstra, “Ocular Disease in Patients with Tuberculosis and HIV Presenting with Fever in Africa,” British Journal of Ophthalmology, Vol. 86, No. 10, 2002, pp. 1076-1079. doi:10.1136/bjo.86.10.1076
[29] Department of Health Services, Ministry of Health, Nepal Government, “TB Facts, Figures and Concepts 2003,” National Tuberculosis Programme, 2003

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.