Many at times, people with HIV(human immunodeficiency virus), go for routine medical check up to monitor their immune system, but fail to acknowledge the fact that the effect of HIV on the eye can be very catastrophic if not well handled. This can be due to lack of awareness, ignorance or poverty,But as the saying goes, if you think sight is expensive try blindness.
SO WHAT IS HIV/AIDS
Many people see HIV and AIDS as similar entity, and somehow make conclusions that someone who is HIV positive could die tomorrow. This is usually not the case hence the need to differentiate between HIV and AIDS becomes very paramount
HIV stands for human immunodeficiency virus and xcan be further broken down into its various component:
Human: it affects humans
Immunodeficiency: There is a compromise in individual immunity
Virus: The causative microorganism is a virus
There are basically 2 types of HIV Virus
HIV1 is the most common in sub-saharan Africa and throughout the world.HIV 1 can be divided into groups, M,N, and O. The pandemic is dominated by group M, which is composed of sub-types A-J.
Hiv 2 is most common in west central africa, parts of Europe and india.
But, one thing is sure, they both produce the same pattern of illness, the only difference is that HIV 2 has a slower progression compared to HIV 1.
AIDS:AIDS stands for Acquired immune deficiency syndrome, AIDS is regarded as the final stage of the disease caused by a group of viruses called the retrovirus.
HIV vs AIDS
HIV is the virus that causes AIDS. Not every one who is infected with the HIV has AIDS. Everyone with AIDS is infected with HIV.HIV infection leads to a weakened immune system and subsequent reduced immune response this is what brings about the symptoms and signs of the viral infection.
HOW DOES HIV WEAKENS THE IMMUNE SYSTEM
The blood contains both white blood cells and red blood cells. The white blood cells specifically play major role in immunity and fighting off and killing of germs which enter the body through one way or the other, all this are achieved through the process of phagocytosis.
So in cases when we have illness and the white blood cells are able to fight of the germs causing the illness, we usually get better, but in case of HIV, the immune system is weakens viz a viz the germ fighting ability.HIV weakens the immune system by entering and destroying our white blood cells, as this process of white blood cells damage is going on, the body becomes more susceptible to further infection. After a prolong period of time germs in the body that ordinarily will not cause any damage, become so pathogenic and deadly.
MODE OF TRANSMISSION
- Unprotected sexual contact with an infected person
- Mother to child transmission, during delivery.
- Transmission through infected body fluids on open wounds
- Infection through contaminated objects
METHOD OF MEASURING LEVEL OF HIV INFECTION OR DIAGNOSIS
- The amount of virus circulating in the body, called the viral load
- The amount of antigen(foreign substance)
- Proteins or cells that protect the body, e.g IgG, IgM antibodies and the CD4 count.
CLINICAL STAGING OF HIV/AIDS IN ADULT
CLINICAL STAGING 1:Asymptomatic
- Asymptomatic
- Persistent generalized Lymphadenopathy
CLINICAL STAGING 2: Mild symptoms
- Moderate unexplained weight loss(less than 10% of body weight).
- Recurrent respiratory tract infections(sinusitis, tonsilitis, otitis media, pharyngitis)
- Herpes zoster
- Angular chelitis
- Recurrent oral ulceration
- Papular pruritic eruption.
CLINICAL STAGIN 3: Advanced symptoms
- Pulmonary tuberculosis
- Recurrent oral candidiasis
- Unexplained chronic diarrhhoea for longer than 30days
- Unexplained persistent fever
- Unexplained anaemia(less than 80g/dl), neutropenia and or chronic thrombocytopenia.
CLINICAL STAGING 4:Severe symptoms
- Karposi sarcoma
- HIV wasting syndrome(loss of more than 10% of body weight with prolonged and unexplained fever or diarrhoea of more than one month)
- HIV encephalopathy
- Extrapulmonary tuberculosis
- Cytomegalovirus invasion of the retina or other organs
- Toxoplasmosis etc.
SO HOW DOES HIV/AIDS AFFECT THE EYES
OCULAR MANIFESTATION OF HIV/AIDS
The ocular manifestation of HIV are very numerous, but the most common ones include but not limited to the following:
Molluscum contagiosum: This is a viral infection of the skin, usually around the eye, it affects about 20% of symptomatic HIV infected individuals,it clinically presents as small painless, umbilicated nodules, which produce discharge that appear waxy in nature on ocular palpation. The main treatment regimen for this complication consist of excision procedure,curettage and cryotherapy.
Herpes zoster Ophthalmicus: This usually occur as as a result of infiltration of the trigerminal nerve with varicella zoster virus,usually very painful and patient will present to the clinic with rash with discharge on one side of the face,which usually respect the midline. Treatment includes the use of oral acyclvir 800mg 5x daily,and also use of topical acyclovir cream.
Anterior uveitis:Uveitis caused by HIV is regarded to occur as a direct effect of the virus,it can also be autoimmune in nature,i.e caused by the body’s own immune response,it can also be as a result of the drug used during the treatment period, it can also be as a result of the other infections caused by the virus like herpes zoster,cytomegalovirus,toxoplasma gondii and syphillis.
Microvasculitis of the retina:In majority of patients that have HIV, there is always abnormality in the vasculature of the retina, which on examination can be seen as intra retinal haemorrhages, micoanaeurysm, although usually asymtomatic.Also cotton wool spots are also visible.The treatment regimen here is to slow or delay the progression of the whole disease process.
Dry eye syndrome: This usually result from the infiltration of the lacrimal gland with the virus and this subsequently leads to the patient having feelings of irritation,tearing and sandy sensation, the treatment here is for the patient to use tear supplement, in other to take care of the symptoms.
Cytomegalovirus retinitis: This happens to be the most common posterior segment anomaly with patient with HIV,it usually manifest clinically as perception of floaters, flashes or mild reduction in vision clarity,treatment here include use of specific antiviral drugs such as cidovir,ganciclovir and forscanet.These drugs can be given through any of the following:intravitreal,intravenous or even orally, in addition to HAART.
Acute retinal necrosis: This will usually present as a whitening of the retina with associated viterous inflammation, with complications of optic neuritis and subsequent retinal detatchment. Management of this condition involves the use of intravenous acyclovir or famciclovir combined with laser therapy to prevent or treat the associated retinal detatchment.
Karposi sarcoma: This is a type of tumour or neoplasm seen exclusively in AIDS patient, it is the most common lesion in the anterior segment of HIV patients,it presents as a violaceous non-tender nodular growth, usually located on the eyelid or conjunctiva. The main treatment technique here involves, chemotherapy, cryotherapy and or Radiotherapy. Other ocular complications include;
Conjunctival squamous cell carcinoma
Progressive outer retinal necrosis
Toxoplasma retinochoroiditis
Syphillis retinitis
Candida albicans endolphthalmitis. Etc
SO WHAT DO YOU DO IF YOU HAVE THE VIRUS
The first thing is to schedule an appointment with the eye Dolctor for proper eye examination to rule out or manage any ocular complication associated with HIV, and for those that have not really gone for testing, you should ensure you do so.
Finally, you must know that we at AFRICA EYE LASER CENTRE BENIN-CITY, EDO-STATE,NIGERIA are well equipped to help diagnose and manage this complications associated with HIV, So book a session with us today and you will be glad you did, Cheers.