Saturday, August 19, 2017

Medicollabowesome: Ocular HIV

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Ophthalmologic lesions occur in about 50% of patients with advanced HIV infection.

These lesions can be classified into :
1) Non-infectious retinopathy.
2) Opportunistic infections caused by viruses, bacteria, fungi, and protozoa.
3) Unusual neoplasms, such as Kaposi’s sarcoma and Burkitt’s lymphoma.
4) Neuro-ophthalmic lesions.

The most common manifestation is the presence of cotton wool spots - localised infarction of the nerve fibre layer of retina. Cotton wool spots are not associated with loss of vision.

The most common opportunistic infection in ocular HIV is CMV retinitis. Majority of these cases are seen when the CD4+ count falls below 50/microL. CMV retinitis presents as painless gradual loss of vision with or without floaters. The fundus examination shows extensive hemorrhage, exudation and necrosis leading to what is known as the "cottage cheese with tomato ketchup" appearance or the "pizza pie" appearance. CMV retinitis may be complicated by a rhegmatogenous retinal detachment.

HSV and HZV can cause an acute bilateral necrotizing retinitis called as the acute retinal necrosis syndrome or the progressive outer retinal necrosis.

Other opportunists include Pneumocystis jiroveci and Toxoplasma gondii, both causing chorioretinitis.

Molloscum contagiosum can affect the eyelids and conjunctiva.

The most common ocular tumor seen due to HIV infection is Kaposi's sarcoma.

Mithil Jagannath.
Medicowesome 2017.

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