Pattern of occular manifestations among adult patients with HIV/AIDS attending HIV clinic at Muhimbili National Hospital - Dar es Salaam.

Abstract

Introduction: HIV, the virus that causes AIDS, “acquired immunodeficiency syndrome,” has become one of the world’s most serious health and development challenges. The estimated prevalence of HIV infection among adults in Tanzania is 5.6%, there are about 1,400,000 total HIV cases. About 86000 people have died from the disease. The available evidence show that an estimate of 70–80% of adult AIDS patients will develop an ocular complication (Orbital and its adnexa) at some point of their illness. Untreated ocular manifestations may cause irreversible blindness or loss of the affected eye and even death. Early detection of these conditions is necessary to allow early diagnosis and appropriate management. Currently no studies have been done in Tanzania on the pattern of ocular manifestations among HIV infected patients. Results of this study will inform the policy makers, eye health stakeholders including health personnel, HIV patients and the general public to put in place strategies that would enable early detection, diagnosis and appropriate management for ocular manifestations in order to prevent blindness and loss of eyes among HIV patients. Aims: To determine the pattern of ocular manifestations among adults patients with HIV/AIDS attending HIV clinic at Muhimbili National Hospital, Dar es Salaam. Methodology: This study was a hospital based cross sectional study conducted at Muhimbili National Hospital, Dar es salaam, Tanzania among adult patients attending HIV clinic. Systematic sampling was used to select patients for the study. All consenting patients underwent a through history for particulars and to determine whether they were on ARV medication. A detailed ocular examination was then done. The results for CD4 count done within 6 months of the study were extracted from the HIV clinic cards. Data were recorded on a semi structured questionnaire and later analyzed using the SPSS version 12.0. Results: A total of 296 patients were recruited, where 153 (51.7%) patients were on ARVs and 143 (48.3%) patients were not on ARV medication. The prevalence of ocular manifestation was 124(41.9%) ,of which 28(18.3%) patients were on ARV and 96(67.1%) were not on ARV`s. Anterior segment Ocular manifestations occurred in 84(14.2%) eyes, followed by the neuro-ophthalmic 79(13.3%) eyes and posterior segment 31,(5.2%).The most common anterior segment manifestation was cataract 25,(29.8%), keratitis 23,(27.4%)eyes and conjunctiva mass in 16,(19 %) eyes. The most common posterior segment manifestation was HIV retinopathy which occurred in 21(67.7%) eyes followed by toxoplasmosis 7, (22.6%) eyes and CMV retinitis 1, (3.2%) eyes. Optic atrophy was the commonest neurophthalmology ocular manifestation that affected 54, (68.4%) eyes. Others eyes had papilledema 13, (16.5%) and pappilitis 12, (15.2%). Most ocular manifestations occurred in patients not on ARV medication. Except for optic atrophy other ocular manifestations tended to increase with decreasing CD4 cell count. Conclusion The study has found out that the prevalence of ocular manifestations in HIV/AIDS patients at Muhimbili National Hospital HIV clinic is high. Most OM occurred in patients who were not on ARV and whose CD4 counts was less than 200 cells per cm3. Cataract, keratitis and conjunctiva mass were the leading anterior segment OM while HIV retinopathy, toxoplasmosis and optic atrophy were the commonest posterior segment and neurophthalmic manifestations respectively. The main causes of blindness were cataract, HIV retinopathy and optic atrophy. Recommendation: It is recommended that routine ocular screening of all patients with HIV be established to identify patients with OM for early diagnosis and appropriate management.