Visual Impairment and Eye Diseases in HIV-infected People in the Antiretroviral Therapy (ART) Era in Rakai, Uganda

ABSTRACT

Purpose

Antiretroviral therapy reduced infectious eye diseases (EDs) in HIV-infected people. There is limited data on age-related EDs and visual impairment (VI) in people living with HIV. We report prevalence of VI and spectrum of EDs in HIV-infected people in an ART era in Rakai, Uganda.

Methods

A philanthropic campaign during 2009–2012 provided ophthalmic services to HIV+ patients in care. Unilateral presenting visual acuity (VA) was assessed by a trained staff in HIV clinics using a 6-m Snellen chart. A slit-lamp examination by an ophthalmologist evaluated eyes with impaired acuity. A retrospective chart review was later conducted retrieving data of patients participating the ophthalmic service. VI was defined referencing WHO’s ICD-11. Ophthalmic diagnosis was summarized by VI level. Logistic regressions estimated demographic associations with cataract diagnosis.

Results

688 HIV+ patients were evaluated, median age was 44 (IQR: 37–50) years, 69% were female. Fifty-one percent were on ART (median duration 4, IQR: 2–5 years). Crude prevalence of moderate/severe VI and blindness were both 2%. The main diagnoses were refractive error (55%), conjunctivitis (18%), cataract (15%), and pterygium (11%). Cataract prevalences were 10%, 12%, and 26% among age groups of 19–34, 35–49, and ≥50 years, respectively. Cataract was found in 73% of the HIV+s with blindness and in 63% of those with moderate/severe VI. Older age and male sex were significantly associated with higher cataract prevalence.

Conclusion

VI in HIV+ patients in Rakai was mainly due to refractive error and cataract. Cataract was common in all age groups.

KEYWORDS:

• HIV
• cataract
• visual impairment
• Africa
• accelerated aging
• blindness
• toxoplasmosis

Acknowledgments

We thank Dr. Steven Reynolds for his input on the study conceptualization.

Disclosure statement

None of the authors have any proprietary interests or conflicts of interest related to this submission.

Additional information

Funding

This work was supported by the National Institute of Allergy and Infectious Diseases [K25AI114461].