Clinical Characteristics of HIV-Associated Optic Neuritis

Figures & data

Table 1 Patient Demographic Data

Cases	Age	Sex	Opportunistic Infections	Number of Affected Eyes	Initial VA (RE, LE)	Optic Disc Appearance	Anterior Chambers	Visual Field Defects	Follow-Up VA (RE, LE)	Drugs	CD4 Counts During ON Episode
Infectious ON Group
1	38	Male	Cryptococcal meningitis	2	1.7, 1.7	Swollen discs with hemorrhage	No inflammation in both eyes	Bilateral generalized depressed field	3, 1.7	Amphotericin B, fluconazole	44
2	30	Male	Cryptococcal meningitis	2	1.7, 2	Swollen discs with hemorrhage	No inflammation in both eyes	Bilateral generalized depressed field	1.7, 2	Amphotericin B, fluconazole	25
3	39	Female	Cryptococcal meningitis	2	0.88, 0.3	Swollen discs with hemorrhage	No inflammation in both eyes	Bilateral generalized depressed field	1.7, 1.7	Amphotericin B, fluconazole	29
4	20	Male	Cryptococcal meningitis	2	1.7, 2.3	Swollen both discs, hemorrhage in the right eye	No inflammation in both eyes	Bilateral generalized depressed field	0.18, 1.7	Amphotericin B, fluconazole, optic nerve sheath fenestration in the left eye	44
5	37	Male	Neuro-syphilis	1	0, 0.88	Swollen left disc with hemorrhage	Inflammation in the left eye	Generalized depressed field	0, 0	Penicillin G sodium	158
6	38	Male	Neuro-syphilis	2	0.4, 0.3	Swollen discs without hemorrhage	No inflammation in both eyes	Bilateral peripheral restriction	0.1, 0	Penicillin G sodium	12
Non-infectious ON group
7	51	Male	No infection	1	0.1, 0.7	Normal optic discs	No inflammation in both eyes	Central scotoma	0.1, 0.3	Intravenous methylprednisolone 1 gram once daily for 3 days	89
8	49	Female	No infection	2	1.3, 1.7	Normal optic discs	No inflammation in both eyes	Central scotoma in the right, generalized depressed field in the left	0.1, 0.1	Intravenous methylprednisolone 1 gram once daily for 5 days	107
9	45	Male	No infection	1	0, 0.4	Swollen left disc with hemorrhage	No inflammation in both eyes	Peripheral restriction	0.1, 0	Intravenous methylprednisolone 1 gram once daily for 3 days	208
10	32	Female	No infection	1	1.7, 0	Normal optic discs	No inflammation in both eyes	Generalized depressed field	0.1, 0	Intravenous methylprednisolone 1 gram once daily for 5 days	371

Figure 1 A 39-year-old HIV-infected female presented with bilateral optic neuritis and cryptococcal meningitis. (A) axial contrast-enhanced T1-weighted images with fat suppression showed enhancement of both optic nerves at the intraorbital, intracanal, and intracranial segments (arrows); (B) coronal contrast-enhanced T1-weighted images with fat suppression showed enhancement of both optic nerves at the intraorbital segments (arrows); (C) coronal contrast-enhanced T1-weighted images with fat suppression showed enhancement of both optic nerves at the intracranial segments (arrows); (D) Axial T2-weighted images with fat suppression showed signal hyperintensity at both cerebral peduncles (arrows) and intraorbital optic nerves; (E) Coronal T2-weighted images with fat suppression showed intracranial optic nerve signal hyperintensity (arrows); (F) axial fluid-attenuation inversion recovery images of the brain showed signal hyperintensity at the genu and posterior limb of left internal capsule (arrowheads); (G) axial contrast-enhanced T1-weighted images of the brain showed abnormal enhancement at the genu and posterior limb of left internal capsule (arrowheads); (H) axial contrast-enhanced T1-weighted images of the brain showed mild leptomeningeal enhancement, suggestive of meningitis.

Figure 2 A 49-year-old HIV-infected female, who received antiretroviral therapy with well-controlled HIV viral load, presented with bilateral optic neuritis (immune reconstitution inflammatory syndrome-associated optic neuritis). (A) axial contrast-enhanced T1-weighted images with fat suppression showed enhancement of both optic nerves at the intracanal and intracranial segments (arrows); (B) coronal contrast-enhanced T1-weighted images with fat suppression showed enhancement of both optic nerves at the intraorbital segments (arrows); (C) coronal contrast-enhanced T1-weighted images with fat suppression showed enhancement of both optic nerves at the intracranial segments (arrows); (D) coronal contrast-enhanced T1-weighted images with fat suppression showed enhancement of the chiasm (arrow).

Figure 3 Diagram showing individual trajectories of the CD4 cell count over time in the non-infectious (immune-mediated) ON group. Each color line and the corresponding arrow color represents each patient. Small arrows represent acute ON attacks. Black dots represent antiretroviral initiation. Black rings represent steroid treatments. Three patients (blue, light blue, and purple lines) successfully achieved HIV infection control. They developed acute ON while their CD4 cell counts were rising, and HIV viral load became undetectable. A female patient (black line), who did not receive ART, developed NMOSD-ON while her CD4 cell counts were 371 cells/µL. All the patients in this group did not have opportunistic infections and were responsive to corticosteroid treatments.