HIV Patients on HAART Have a Plethora of Ocular Diseases

Fran Lowry

November 01, 2011

November 1, 2011 (Orlando, Florida) — HIV-positive patients receiving highly active antiretroviral therapy (HAART) have a prevalence of cataracts that is well above that of the general population and a plethora of other ocular diseases, researchers reported here at the American Academy of Ophthalmology 2011 Annual Meeting.

What is particularly alarming is the fact that the cataracts are occurring in a much younger population, presenter Brian Toussaint, MD, from Georgetown University Hospital and Washington Hospital Center, DC, told Medscape Medical News.

"We are even seeing people in their mid-40s. In our study, which looked at 102 patients, 40% of patients aged 40 to 49 had cataracts; nationally, only 2.5% of people in that age range have cataracts. In the 50- to 59-year age group, 72% had cataracts; nationally, that rate is 6.8%," Dr. Toussaint said. "The doctors in my group are having to do cataract surgery on patients in their 40s, when normally we are looking at doing cataract surgery on patients in their 60s."

Dr. Brian Toussaint

In this retrospective review, Dr. Toussaint and his team identified 44 different diagnoses among HIV patients receiving HAART. The most common was refractive error (58 patients), followed by nuclear cataracts (42 patients), suspected glaucoma (13 patients), and dry eye syndrome (10 patients). Other diagnoses included punctate epithelial erosion, blepharitis, hypertension retinopathy, posterior subcapsular cataract, primary open-angle glaucoma, exotropia, herpes zoster, superficial punctate keratopathy, myopic degeneration, chronic retinal detachment, HIV retinopathy, corneal abrasion, and central retinal vein occlusion.

Of note, there were no cases of cytomegalovirus retinitis, Dr. Toussaint reported.

Additionally, there was no correlation between CD4 count and the development of cataracts.

Dr. Toussaint pointed out that the retroviral protease of HIV-1 can cause cataract formation; when this is inhibited, cataract formation is prevented. However, in this review, there was no statistically significant difference in cataract formation between people who were taking protease inhibitors and those who were not.

"The odds ratio for cataracts was 7% lower for patients on protease inhibitors [odds ratio, 0.93; 95% confidence interval, 0.42 to 2.05]. While this could be said to be somewhat protective, it was not significant," Dr. Toussaint explained.

The ophthalmologic exam is vital to the care of these patients, he added. "We identified 44 different diagnoses, and most of the time the patients just came in saying 'I've got blurry vision.' Practitioners need to be vigilant and give them a thorough work-up."

Dr. Toussaint has disclosed no relevant financial relationships.

American Academy of Ophthalmology (AAO) 2011 Annual Meeting: Abstract PO041. Presented October 23, 2011.

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