Anterior Segment and Ocular Adnexal Lesions in Patients with Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome at a Tertiary Hospital in Southwestern Nigeria

Abstract

Background: Ocular manifestation of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) affects various ocular  structures including the anterior segment and ocular adnexae and may be a cause of ocular morbidity. The aim of the study is to determine the pattern  of lesions affecting the anterior segment and ocular adnexae in patients diagnosed with HIV/AIDS whether on highly active antiretroviral therapy or not  and confirmed positive for retroviral disease by western blot attending an antiretroviral therapy clinic in Southwestern Nigeria. It is a prospective,  cross‑sectional study on anterior segment and ocular adnexae lesions in patients with HIV/AIDS.

Materials and Methods: A total of 318 consecutive  patients with the confirmation of a diagnosis of HIV/AIDS attending the antiretroviral therapy clinic within the study period from 2009 to 2010 had visual  acuity evaluation, a detailed ocular examination by slit‑lamp biomicroscopy, and binocular indirect ophthalmoscopy. The data generated were analysed  using SPSS (Statistical Package for the Social Sciences) version 16. Ethical clearance was obtained from the hospital research ethics committee.

Results:  Two hundred and ninety‑five (92.8%) patients of the 318 recruited had anterior segment manifestations, whereas ocular adnexal lesions were present in  134 (42.1%) patients. Multiple ocular pathology of the anterior segment and ocular adnexal was present in some of the respondents recruited. There  were more female respondents. One hundred and twenty‑three patients(38.7%) recruited for the study were in the 40–49 years of age group with a mean  age of 47.2 years(SD = 9.42 years). The most common anterior segment lesion was corneal opacity in 18 patients (5.6%), and the most common  ocular adnexal lesion was pingueculum in 56 respondents (17.6%). Other HIV/AIDS‑associated adnexal lesions present include hypertrichosis in 25  patients (7.9%), herpes zoster ophthalmicus (HZO) in 13 (4.1%), and squamous cell carcinoma of the conjunctiva in 4 (1.3%) patients. The most common HIV‑associated anterior segment pathology was HZO‑associated keratouveitis seen in four patients (1.3%) and herpes simplex keratitis in one patient  (0.3%). Conjunctival microangiopathy was the most common HIV‑associated ocular adnexal lesion. The relationship between viral load values and lesions  involving both anterior segment and ocular adnexal disease was statistically significant as these patients tended to have higher viral loads when  compared with those without lesions (P < 0.05). 

Conclusion: Anterior segment and ocular adnexal lesions were frequent in patients with HIV/AIDS  attending a tertiary health institution in urban Nigeria. HIV/AIDS‑defining ocular illnesses including HZO, conjunctival microangiopathy, and ocular  surface squamous cell neoplasia are not uncommon in these patients. Potentially debilitating ocular disorders may be avoided by instituting periodic  ocular examinations.