Ocular Complications of HIV/AIDS in the Era of HAART

Millena G Bittencourt; Owhofasa O Agbedia; Hong T Liu; Rachel Annam; Yasir J Sepah; Henry Alexander Leder; Raafay Sophie; Mohamed Ibrahim; Abeer Akhtar; Anam Akhlaq; Diana V Do; Quan Dong Nguyen


Expert Rev Ophthalmol. 2012;7(6):555-564. 

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Expert Commentary

During the pre-HAART era, the main concern for ophthalmologists was to stop the progression of opportunistic infection to prevent blindness. As AIDS is now a chronic disease, with survival after infection estimated to be greater than 14 years, the complications of aggressive antiviral therapy have become more relevant to preserve the quality of life of affected patients. The antiviral therapies and different administrative routes have individual advantages but also side effects and complications that should be monitored regularly. The treatment of these patients should be individualized and the choice of therapy should be based on several factors, including the location of the lesion and the patient's experience with HAART. Intravitreal injections have the added advantage of less systemic toxicity and delivery of higher concentrations of the drug to the posterior segment; however, rapid clearance of small particles requires repeated injections at relatively short intervals, which increases the risk of complications related to intravitreal injections. Implants have the advantage of sustained release of the drug without the inconvenience of repeated intravitreal injections. However, the process of inserting the implant is associated with complications such as development and progression of cataract, vitreous hemorrhages, retinal detachment, epiretinal membranes, hypotony, CME and endophthalmitis. Educating patients about the signs and symptoms of ocular complications of HIV is an important part of the management of these patients. Routine monitoring is also essential in the management of these patients, even those patients with immune recovery.