Lowering the limit: reducing the CD4 T-cell threshold for ophthalmic screening in patients with HIV in an ethnically diverse UK population

Figures & data

Table 1 Comparison between patients screened during the two study periods

Characteristic	Screening period 1 (2007–2008)	Screening period 2 (2011–2012)	P-value
Number of patients	24	27
Sex, n (%)			1.00*
Male	17 (71)	20 (74)
Female	7 (29)	6 (26)
Ethnicity, n (%)			0.048*
Caucasian	13 (54)	9 (33)
African/Afro-Caribbean	7 (29)	16 (60)
European	4 (17)	2 (7)
Asian	0 (0)	0 (0)
CD4 count (cell/mm^3), n (%)			0.034**
0–50	5 (19)	11 (40)
51–100	3 (11.5)	7 (26)
101–200	3 (11.5)	2 (7)
>200	13 (50)	7 (26)
No result	2 (8)	0
Median	253	62
CD4%			0.274**
Median (interquartile range)	18.0 (8.8–26.1)	10 (4–22.0)
HIV RNA, copies/mm^3			0.0079**
Median (interquartile range)	51 (40–7,891)	19,990 (188–627,525)
Cytomegalovirus immunoglobulin G (%)			1.00*
Positive	18 (75)	21 (78)
Negative	6 (25)	6 (22)
Ophthalmic manifestations of HIV, n (%)			1.00*
Present	3 (13)	4 (15)
Not present	21 (87)	23 (85)

Notes:

* Fisher’s exact test of (1) male versus female, (2) African/Afro-Caribbean versus all other ethnicities, (3) cytomegalovirus immunoglobulin G-positive versus immunoglobulin G-negative, and (4) ophthalmic manifestations of HIV present versus not present.

** Mann–Whitney test.

Table 2 Characteristics of patients diagnosed with cytomegalovirus retinitis and HIV retinopathy

Characteristic	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7
CD4 count (cells/mm^3)	7	77	6	82	80	9	8
HIV viral load (copies/mm^3)	38,147	429,196	Not known	Not known	999,764	984,513	989,788
Highly active antiretroviral therapy at time of ophthalmic assessment	Yes	No	No	No	No	No	No
Symptoms at presentation	None	None	None	None	None	None	None
Clinical findings	Cotton wool spots	Cotton wool spots	Retinal necrosis, hemorrhages	Cotton wool spots, telangiectasia	Cotton wool spots	Cotton wool spots, blot hemorrhages	Cotton wool spots
Unilateral/bilateral disease	Bilateral	Bilateral	Bilateral	Bilateral	Bilateral	Bilateral	Bilateral
Ocular diagnosis	HIV retinopathy	HIV retinopathy	Cytomegalovirus retinitis	HIV retinopathy	HIV retinopathy	HIV retinopathy	HIV retinopathy
Ophthalmic treatment	Observation only	Observation only	Intravenous ganciclovir induction then maintenance oral valganciclovir plus intravitreal ganciclovir (low compliance to treatment)	Observation only	Observation only	Observation only	Observation only
Outcome	No visual consequences	No visual consequences	Visual loss to hand movements (RE); six of nine LE; patient died 17 months after ophthalmic presentation	No visual consequences	No visual consequences	No visual consequences	No visual consequences

Abbreviations: RE, right eye; LE, left eye.