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

Ophthalmic Epidemiol. 2021 Feb;28(1):63-69. doi: 10.1080/09286586.2020.1791908. Epub 2020 Jul 14.

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: Africa; HIV; accelerated aging; blindness; cataract; toxoplasmosis; visual impairment.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Female
  • HIV Infections* / complications
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • Humans
  • Infant, Newborn
  • Male
  • Retrospective Studies
  • Uganda / epidemiology
  • Vision Disorders / epidemiology
  • Visually Impaired Persons*