COMMON POSTERIOR SEGMENT MANIFESTATIONS OF THE HIV POSITIVE PATIENT
Padhmalatha Segu, O.D.
Clinical Associate Professor
University of Houston
College of Optometry
505 J. Armistead Bldg
Houston, TX 77204-6052
713-743-1958/psegu@uh.edu
Abstract
This course focuses on the common posterior segment manifestations in patients who are seropositive for the human immunodeficiency virus(HIV). The course will review background information on HIV, new antiretroviral medication used in the management of HIV positive patients, non-infectious retinopathy, cytomegalovirus(CMV) retinitis, management and treatment options for CMV retinitis, toxoplasmosis chorioretinitis, and progressive outer retinal necrosis.
Learning Objectives
1.
2.
To become familiar with the clinical presentation of non-infectious retinopathy
To understand the role of antiretroviral therapy in the management of CMV
3.
4. retinitis
To become familiar with the clinical presentation of CMV retinitis
To become knowledgeable about the treatment options available for CMV retinitis
5.
5.
6.
To understand the role of antiretroviral therapy in the management of CMV retinitis
To become familiar with the clinical presentation of toxoplasmosis in HIV patients
To become familiar with the clinical presentation of progressive outer retinal necrosis in HIV patients
Outline
II
I.
B.
General information
A. Human immunodeficiency virus
1.
2.
Retrovirus
Forms of HIV
3.
4.
Replication of the HIV virus
Definition of AIDS
CD4 Count and Viral Load
1. Review the changes in the CD4 count and viral load
C.
2. with HIV infection
Frequency of eye exams
Antiretroviral Medication
1. Reverse Transcriptase Inhibitors
2.
3.
Protease Inhibitors
HAART Therapy
Posterior Segment Manifestations
A. Non-infectious retinopathy
1.
2.
Clinical presentation
Pathophysiology

B.
C.
D.
3.
4.
Significance of non-infectious retinopathy
How to differentiate from early CMV retinitis
CMV retinitis
1.
2.
3.
4.
5.
1.
2.
3.
1.
2.
Clinical presentation
Forms of CMV retinitis
Treatment for CMV retinitis a. b. c. d.
Ganciclovir
1)
2)
3)
Intravenous
Oral
Intraocular implant
Foscarnet
Cidofovir
Formivirsen
Regression of CMV retinitis
CMV and antiretroviral therapy
Toxoplasmosis Chorioretinitis
Clinical presentation
Acquired infection in HIV patients
Neuro-imaging is indicated
Progressive outer retinal necrosis (PORN)
Clinical presentation
Unsuccessful with treatment
3. Poor Visual Prognosis
III. Case Presentations
A.
B.
Non-infectious retinopathy case
CMV retinitis case
C.
D.
IV. Reading References
1. Kim VY, Duker JS, Ocular Manifestations of human immunodeficiency virus.
2.
CMV retinitis case
Toxoplasmosis case
Seminars in Ophthalmology 11:1:1996 March. 93-106.
Bright, DC, Antiretroviral therapy for HIV infection: a review of current medications and
3.
4.
5.
6.
7. therapies. J of the AOA 70:6:1999 June. 355-383.
Reed JB, Schwab IR, Gordon J, Morse LS, Regression of cytomegalovirus retinitis associated with protease-inhibitors treatment I patients with AIDS. Am J Ophthalmology
124:2:1997 Aug. 199-205.
Harkins T, Noninfectious retinopathy. Optometry and Vision Science 72:5:1995. 302-304
Ballinger R, CMV retinitis. Optometry and Vision Science 72:5:1995. 305-9.
Bright, DC, Pharmacologic management of CMV retinitis: review of current and future therapeutic modalities, J of the AOA 68:1:1997 Jan. 11-30.
Marks ES, Adamczyk DT, Thomann KH. Primary Eyecare in Systemic Disease, Appleton and Lange, 1995.