Spectrum of Ocular Findings in HIV Patients in Correlation with Cd4+ Cell Count in a Tertiary Care Centre of North India

Background: Human immunodeficiency virus (HIV) infection remains a major global health concern and is associated with a broad spectrum of ocular manifestations involving the ocular adnexa, anterior segment, posterior segment, and neuro-ophthalmic pathways. The pattern of ophthalmic involvement has evolved considerably following the widespread use of combination antiretroviral therapy, resulting in a decline in opportunistic infections and a relative increase in chronic anterior-segment disorders. Because ocular manifestations may occur across different stages of immune suppression and occasionally represent the earliest clinical indicator of disease progression, comprehensive ophthalmic evaluation continues to play an important role in the multidisciplinary management of patients with HIV infection. Assessment of ocular manifestations in relation to CD4+ T-lymphocyte count remains clinically relevant for understanding the current spectrum of disease in the era of antiretroviral therapy. The aim is to determine the spectrum of ocular manifestations in patients with HIV infection and to describe their distribution according to CD4+ T-lymphocyte count categories. Material and Methods: This article presents a cross-sectional analysis of baseline data derived from a prospective observational study conducted in the Department of Ophthalmology in collaboration with the Antiretroviral Therapy (ART) Centre at Government Medical College and Rajindra Hospital, Patiala, Punjab. A total of 150 patients with HIV infection aged 20–60 years were enrolled using a consecutive (non-probability) sampling technique, irrespective of ocular symptoms or antiretroviral treatment status. The present analysis included only findings recorded during the baseline (first-visit) ophthalmic examination. All participants underwent comprehensive ophthalmic evaluation, including assessment of visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, Schirmer test I, ocular motility assessment, and dilated fundus examination. Optical coherence tomography and fundus photography were performed whenever clinically indicated. Clinical findings were documented separately for the right and left eyes and were analysed according to five predefined CD4+ T-lymphocyte categories (≤50, 51–100, 101–200, 201–500, and >500 cells/mm³). Continuous variables were summarized as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. Results: The study included 150 patients (300 eyes) with a mean age of 42.51 ± 11.13 years and a mean CD4+ T-lymphocyte count of 334.53 ± 140.82 cells/mm³. The majority of participants belonged to the 201–500 cells/mm³ category. Anterior-segment manifestations were more common than posterior-segment abnormalities. No anterior-segment abnormality was observed in 32.7% of right eyes and 36.0% of left eyes. Cataract was the most frequent anterior-segment manifestation, affecting 20.0% of right eyes and 17.3% of left eyes, followed by dry-eye disease, which was identified in 15.3% and 16.0% of right and left eyes, respectively. Posterior-segment manifestations were relatively uncommon, with no abnormality detected in 86.0% of right eyes and 83.3% of left eyes. Retinal microangiopathy was the most frequent posterior-segment manifestation, whereas cytomegalovirus retinitis was observed in only one eye on each side and was confined to patients with CD4+ counts between 51 and 100 cells/mm³. Ocular manifestations were observed across all CD4+ categories; however, no consistent lesion-specific distribution was evident. Conclusion: Anterior-segment manifestations, particularly cataract and dry-eye disease, constituted the predominant ophthalmic findings among patients with HIV infection, whereas posterior-segment opportunistic manifestations were relatively infrequent. Ocular manifestations were identified across the full spectrum of CD4+ T-lymphocyte categories, indicating that clinically significant ophthalmic involvement is not restricted to advanced immunosuppression. These findings emphasize the importance of comprehensive bilateral ophthalmic examination in all patients with HIV infection, irrespective of presenting CD4+ T-lymphocyte count.

Keywords: HIV infection; ocular manifestations; CD4+ T-lymphocyte count; cataract; dry-eye disease; retinal microangiopathy.